Provider Demographics
NPI:1164442380
Name:SHUFFLER, BRIAN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MARK
Last Name:SHUFFLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:315 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3517
Mailing Address - Country:US
Mailing Address - Phone:610-566-0591
Mailing Address - Fax:610-566-0591
Practice Address - Street 1:1425 ARCH ST
Practice Address - Street 2:YMCA BUILDING, FIRST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1507
Practice Address - Country:US
Practice Address - Phone:215-557-9090
Practice Address - Fax:215-557-9089
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC00838111N00000X
PADC008838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor