Provider Demographics
NPI:1922257641
Name:SHENKLE, BRIAN IV
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SHENKLE
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29040 MCMILLEN RD
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-9290
Mailing Address - Country:US
Mailing Address - Phone:937-578-4061
Mailing Address - Fax:
Practice Address - Street 1:29040 MCMILLEN RD
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-9290
Practice Address - Country:US
Practice Address - Phone:937-578-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker