Healthcare Provider Details

I. General information

NPI: 1164442380
Provider Name (Legal Business Name): BRIAN MARK SHUFFLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 ARCH ST YMCA BUILDING, FIRST FLOOR
PHILADELPHIA PA
19102-1507
US

IV. Provider business mailing address

315 E STATE ST
MEDIA PA
19063-3517
US

V. Phone/Fax

Practice location:
  • Phone: 215-557-9090
  • Fax: 215-557-9089
Mailing address:
  • Phone: 610-566-0591
  • Fax: 610-566-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC00838
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008838
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: