Provider Demographics
NPI:1447433727
Name:SHEEHAN, TIMOTHY JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-0127
Mailing Address - Country:US
Mailing Address - Phone:320-485-2380
Mailing Address - Fax:320-485-4548
Practice Address - Street 1:421 6TH ST S
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-1103
Practice Address - Country:US
Practice Address - Phone:320-485-2380
Practice Address - Fax:320-485-4548
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C470SHOtherBLUE CROSS BLUE SHIELD
MN3C470SHOtherBLUE CROSS BLUE SHIELD