Provider Demographics
NPI:1104995562
Name:BURKE, SHEA L (DC)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:L
Last Name:BURKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHEA
Other - Middle Name:L
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4381
Mailing Address - Country:US
Mailing Address - Phone:508-325-4777
Mailing Address - Fax:508-228-7024
Practice Address - Street 1:4 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4381
Practice Address - Country:US
Practice Address - Phone:508-325-4777
Practice Address - Fax:508-228-7024
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1040604OtherASH
MA7041469OtherAETNA
MA7041469OtherAETNA
MAU94412Medicare UPIN