Provider Demographics
NPI:1801281092
Name:SHELMADINE, BRIAN DWIGHT (DO, PHD, CSCS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DWIGHT
Last Name:SHELMADINE
Suffix:
Gender:M
Credentials:DO, PHD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 CAREGIVER CIR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8529
Mailing Address - Country:US
Mailing Address - Phone:605-755-6100
Mailing Address - Fax:
Practice Address - Street 1:1635 CAREGIVER CIR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8529
Practice Address - Country:US
Practice Address - Phone:605-755-6100
Practice Address - Fax:605-755-6101
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11546207QS0010X
TXR1876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine