=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639275779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL T. SHEA DC,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 N STATE ST
-----------------------------------------------------
City | BIG RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49307-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-796-3935
-----------------------------------------------------
Fax | 231-796-3510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 621 N STATE ST
-----------------------------------------------------
City | BIG RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49307-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-796-3935
-----------------------------------------------------
Fax | 231-796-3510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL THOMAS SHEA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 231-796-3935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301005115
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------