Healthcare Provider Details

I. General information

NPI: 1124208103
Provider Name (Legal Business Name): CHERYL SHEA, DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

10807 BIG BEND RD
SAINT LOUIS MO
63122-6054
US

IV. Provider business mailing address

10807 BIG BEND RD
SAINT LOUIS MO
63122-6054
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-7900
  • Fax:
Mailing address:
  • Phone: 314-822-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004004115
License Number StateMO

VIII. Authorized Official

Name: CHERYL SHEA
Title or Position: OWNER
Credential: DC
Phone: 314-822-7900