Provider Demographics
NPI:1205974904
Name:SHEEDY, PAULA KAY (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:KAY
Last Name:SHEEDY
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 1:1122 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-3703
Mailing Address - Country:US
Mailing Address - Phone:563-359-6400
Mailing Address - Fax:563-359-3543
Practice Address - Street 1:3515 SPRING ST
Practice Address - Street 2:SUITE #3
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2100
Practice Address - Country:US
Practice Address - Phone:563-359-6400
Practice Address - Fax:563-359-3543
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0051102Medicaid
IA27140OtherWELLMARK BLUE CROSS
IA27140Medicare ID - Type Unspecified