MEDICARE: CHERYL SHEA, DC PC

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	2004004115	MO

General Provider Information

NPI Number	:	1124208103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERYL SHEA, DC PC

Provider Business Mailing Address
First Line	:	10807 BIG BEND RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-6054
Country	:	US
Telephone Number	:	314-822-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	10807 BIG BEND RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-6054
Country	:	US
Telephone Number	:	314-822-7900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHERYL SHEA
Credential	:	DC
Telephone Number	:	314-822-7900

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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