Provider Demographics
NPI:1811069974
Name:SHERIDAN, JOSEPH PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:SHERIDAN
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 1:270 HUTTLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1605
Mailing Address - Country:US
Mailing Address - Phone:508-997-9100
Mailing Address - Fax:508-993-5854
Practice Address - Street 1:270 HUTTLESTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-1605
Practice Address - Country:US
Practice Address - Phone:508-997-9100
Practice Address - Fax:508-993-5854
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44-00351OtherUNITED HEALTH CARE #
MAY4509301OtherMEDICARE ACTIVE PROVIDER TRANSACTION ACCESS NUMBER(PTAN)
MA351-249OtherHARVARD PILGRIM PROVIDER
MAY36493OtherBCBS PROVIDER #
MA1872698OtherCIGNA PROVIDER #
MD23216-4OtherRI BCBS PROVIDER #