Provider Demographics
NPI:1700073418
Name:SHEEHAN, KELLY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JOHN
Last Name:SHEEHAN
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 1:12321 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3964
Mailing Address - Country:US
Mailing Address - Phone:952-933-4427
Mailing Address - Fax:952-939-9843
Practice Address - Street 1:12321 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-3964
Practice Address - Country:US
Practice Address - Phone:952-933-4427
Practice Address - Fax:952-939-9843
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor