Provider Demographics
NPI:1861640237
Name:FAHEY, SHEILA MAUREEN (DC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MAUREEN
Last Name:FAHEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 EXCELSIOR BLVD
Mailing Address - Street 2:#110
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:612-925-5776
Mailing Address - Fax:
Practice Address - Street 1:3947 EXCELSIOR BLVD
Practice Address - Street 2:#110
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:612-925-5776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor