Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3313 | MA |
N | 111NS0005X | Chiropractic Sports Physician | 3313 | MA |
NPI | 1083946578 |
---|---|
Provider Name | Dr. Alexa Loring Shea |
First Address | Watertown, MA 02472-4238 |
Second Address | Watertown, MA 02472-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2010 |
Last Update Date | 07/02/2019 |