Provider Demographics
NPI:1215933288
Name:BROHL, SHAWN K (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:K
Last Name:BROHL
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 1:6823 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9487
Mailing Address - Country:US
Mailing Address - Phone:419-866-6325
Mailing Address - Fax:
Practice Address - Street 1:6823 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9487
Practice Address - Country:US
Practice Address - Phone:419-866-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2089111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000121954OtherANTHEM
OH311574247-02OtherMMOH
OH0107637Medicaid
OH02917OtherPARAMOUNT
OH703052OtherBUCKEYE COMMUNITY HEALTH
OH5979300OtherAETNA
OH311574247-00OtherWORKERS COMP
OH703052OtherBUCKEYE COMMUNITY HEALTH
OH0107637Medicaid