Provider Demographics
NPI:1215093380
Name:SHARA, MICHAEL J (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SHARA
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 1:14201 W 84TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4100
Mailing Address - Country:US
Mailing Address - Phone:913-888-4064
Mailing Address - Fax:
Practice Address - Street 1:6220 ANTIOCH RD
Practice Address - Street 2:SUITE 212
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66202-2866
Practice Address - Country:US
Practice Address - Phone:913-262-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor