MEDICARE: DR. BENJAMIN SANFORD SHEEHAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12977	TX

General Provider Information

NPI Number	:	1083080790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN SANFORD SHEEHAN D.C.

Provider Business Mailing Address
First Line	:	12020 10TH ST
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-8623
Country	:	US
Telephone Number	:	409-599-9697
Fax Number	:

Provider Business Practice Location Address
First Line	:	3027 MARINA BAY DR
Second Line	:	SUITE 203
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2729
Country	:	US
Telephone Number	:	409-599-9697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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