Provider Demographics
NPI:1194875245
Name:SHEELY, ROBERT B (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:SHEELY
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 1:1002 N UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3300
Mailing Address - Country:US
Mailing Address - Phone:513-217-7035
Mailing Address - Fax:513-318-4973
Practice Address - Street 1:1002 N UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3300
Practice Address - Country:US
Practice Address - Phone:513-217-7035
Practice Address - Fax:513-318-4973
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000010589OtherANTHEM ID
OH0841C01OtherHUMANA
OH311021750026OtherCARESOURCE
OHL0437085Medicaid
OH31-1021750OtherTAX ID
OHL0437085Medicaid
OH0486911Medicare ID - Type UnspecifiedMEDICARE NUMBER