Provider Demographics
NPI:1013965664
Name:SCHEIDEMAN, BRENT (DC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SCHEIDEMAN
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:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-0265
Mailing Address - Country:US
Mailing Address - Phone:763-262-2639
Mailing Address - Fax:763-262-2640
Practice Address - Street 1:14030 BANK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-9351
Practice Address - Country:US
Practice Address - Phone:763-262-2639
Practice Address - Fax:763-262-2640
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4037111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN449M3SCOtherBCBS