Provider Demographics
NPI:1427128313
Name:SHERIDAN, SEAN SHAMUS (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:SHAMUS
Last Name:SHERIDAN
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 1:28647 MIDDLESBROUGH CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7896
Mailing Address - Country:US
Mailing Address - Phone:951-679-4142
Mailing Address - Fax:951-672-0680
Practice Address - Street 1:26900 NEWPORT RD STE 110
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9224
Practice Address - Country:US
Practice Address - Phone:951-672-8060
Practice Address - Fax:951-672-7490
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23641ZMedicare ID - Type Unspecified