Provider Demographics
NPI:1922216670
Name:MOONEY, SHAWN ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ERIC
Last Name:MOONEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2031
Mailing Address - Country:US
Mailing Address - Phone:216-476-1700
Mailing Address - Fax:216-476-1701
Practice Address - Street 1:3310 WARREN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2031
Practice Address - Country:US
Practice Address - Phone:216-476-1700
Practice Address - Fax:216-476-1701
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010389111N00000X
OH4020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor