Provider Demographics
NPI:1083044283
Name:BRENEMAN, SHEA M (DC)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:M
Last Name:BRENEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 172ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-5484
Mailing Address - Country:US
Mailing Address - Phone:563-340-1220
Mailing Address - Fax:
Practice Address - Street 1:1507 172ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-5484
Practice Address - Country:US
Practice Address - Phone:563-340-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60402217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor