Provider Demographics
NPI:1386758670
Name:EAGAN, SHARON (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:EAGAN
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 1:268 STATE ST # 3
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2670
Mailing Address - Country:US
Mailing Address - Phone:610-555-1212
Mailing Address - Fax:
Practice Address - Street 1:268 STATE ST # 3
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2670
Practice Address - Country:US
Practice Address - Phone:610-555-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009044/AJ008875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMP00920078OtherMALPRACTICE
PA7682581OtherAETNA
PA1062226OtherASH COMPANIES
PA2329279000OtherINDEPENDENCE BLUE CROSS
PAAJ008875OtherADJUNCTIVE LICENSE NUMBER
PADC009044OtherLICENSE NUMBER
PAV00474Medicare UPIN
PA080974Medicare ID - Type Unspecified