Provider Demographics
NPI:1508882069
Name:HAVIS, SHARON LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LEE
Last Name:HAVIS
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 1:29530 HIGHMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3002
Mailing Address - Country:US
Mailing Address - Phone:248-804-1220
Mailing Address - Fax:248-539-1901
Practice Address - Street 1:29530 HIGHMEADOW RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3002
Practice Address - Country:US
Practice Address - Phone:248-804-1220
Practice Address - Fax:248-539-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002839L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034196OtherINDEPENDENCE
PA0048405000OtherKEYSTONE HPE
PA034196OtherINDEPENDENCE