Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2089 | OH |
NPI | 1215933288 |
---|---|
Provider Name | Shawn K Brohl |
First Address | Holland, OH 43528-9487 |
Second Address | Holland, OH 43528-9487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 29/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000121954 | ANTHEM (01) | OH |
0107637 | (05) | OH |
02917 | PARAMOUNT (01) | OH |
311574247-00 | WORKERS COMP (01) | OH |
311574247-02 | MMOH (01) | OH |
5979300 | AETNA (01) | OH |
703052 | BUCKEYE COMMUNITY HEALTH (01) | OH |
U52960 | (02) | OH |