Provider Demographics
NPI:1104164102
Name:SHEA SPORTS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SHEA SPORTS CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-660-5813
Mailing Address - Street 1:1820 TURNPIKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6398
Mailing Address - Country:US
Mailing Address - Phone:978-688-6181
Mailing Address - Fax:978-688-5120
Practice Address - Street 1:1820 TURNPIKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6398
Practice Address - Country:US
Practice Address - Phone:978-688-6181
Practice Address - Fax:978-688-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3313111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty