Provider Demographics
NPI:1306905260
Name:BIANCO, SHARON M (DC)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:BIANCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2918
Mailing Address - Country:US
Mailing Address - Phone:313-386-1050
Mailing Address - Fax:313-386-2103
Practice Address - Street 1:5000 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2918
Practice Address - Country:US
Practice Address - Phone:313-386-1050
Practice Address - Fax:313-386-2103
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4441756-14Medicaid
MI950Q250020OtherBCBS
MIM72100001Medicare ID - Type Unspecified
MI4441756-14Medicaid