Provider Demographics
NPI:1558751842
Name:STADDON, BRENT (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:STADDON
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 1:1124 KENNEBEC DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2809
Mailing Address - Country:US
Mailing Address - Phone:717-263-8919
Mailing Address - Fax:
Practice Address - Street 1:1124 KENNEBEC DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2809
Practice Address - Country:US
Practice Address - Phone:717-263-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor