MEDICARE: DR. BRIAN MARK SHUFFLER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC00838	PA
2	111N00000X	Chiropractor	DC008838	PA

General Provider Information

NPI Number	:	1164442380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MARK SHUFFLER D.C.

Provider Business Mailing Address
First Line	:	315 E STATE ST
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-3517
Country	:	US
Telephone Number	:	610-566-0591
Fax Number	:	610-566-0591

Provider Business Practice Location Address
First Line	:	1425 ARCH ST
Second Line	:	YMCA BUILDING, FIRST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1507
Country	:	US
Telephone Number	:	215-557-9090
Fax Number	:	215-557-9089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	09/09/2008

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