Provider Demographics
NPI:1053758177
Name:SHAKER WOMEN'S WELLNESS, LLC
Entity type:Organization
Organization Name:SHAKER WOMEN'S WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SEDGWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-220-8769
Mailing Address - Street 1:20850 SYDENHAM RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-2926
Mailing Address - Country:US
Mailing Address - Phone:216-220-8769
Mailing Address - Fax:216-324-7077
Practice Address - Street 1:20850 SYDENHAM RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2926
Practice Address - Country:US
Practice Address - Phone:216-220-8769
Practice Address - Fax:216-324-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty