Provider Demographics
NPI:1922009406
Name:SHEADER, WES E (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:WES
Middle Name:E
Last Name:SHEADER
Suffix:
Gender:M
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 PATTERSON RD STE 15
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1098
Mailing Address - Country:US
Mailing Address - Phone:970-254-2954
Mailing Address - Fax:970-254-2958
Practice Address - Street 1:2532 PATTERSON RD STE 15
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1098
Practice Address - Country:US
Practice Address - Phone:970-254-2954
Practice Address - Fax:970-254-2958
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO542598Medicare PIN
COU82803Medicare UPIN