Healthcare Provider Details

I. General information

NPI: 1215933288
Provider Name (Legal Business Name): SHAWN K BROHL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823 SPRING VALLEY DR
HOLLAND OH
43528-9487
US

IV. Provider business mailing address

6823 SPRING VALLEY DR
HOLLAND OH
43528-9487
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-6325
  • Fax:
Mailing address:
  • Phone: 419-866-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: