Provider Demographics
NPI:1952629479
Name:SHEA, KIMBERLY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:SHEA
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 1:114 N. MARYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CALMAR
Mailing Address - State:IA
Mailing Address - Zip Code:52132
Mailing Address - Country:US
Mailing Address - Phone:563-880-0991
Mailing Address - Fax:563-562-3362
Practice Address - Street 1:114 N MARYVILLE ST
Practice Address - Street 2:
Practice Address - City:CALMAR
Practice Address - State:IA
Practice Address - Zip Code:52132-8520
Practice Address - Country:US
Practice Address - Phone:563-880-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007289111N00000X
WI4620-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor