Healthcare Provider Details

I. General information

NPI: 1104996008
Provider Name (Legal Business Name): SHAMUS SEAN SHERIDAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 NEWPORT RD STE 110
MENIFEE CA
92584-9224
US

IV. Provider business mailing address

30680 SHORERIDGE DR
MENIFEE CA
92584-8401
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-8060
  • Fax: 951-672-7490
Mailing address:
  • Phone: 951-672-4508
  • Fax: 951-672-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: