Provider Demographics
NPI:1780727412
Name:TIERNEY, SHAWN PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3939 ATLANTIC AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3536
Mailing Address - Country:US
Mailing Address - Phone:562-424-5505
Mailing Address - Fax:562-424-1055
Practice Address - Street 1:3939 ATLANTIC AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3536
Practice Address - Country:US
Practice Address - Phone:562-424-5505
Practice Address - Fax:562-424-1055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24011OtherSTATE LICENSE NUMBER
CAU63858Medicare UPIN