Provider Demographics
NPI:1538197702
Name:SHORT, BRETT ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALLEN
Last Name:SHORT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:99 CRACKER BARREL DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1622
Mailing Address - Country:US
Mailing Address - Phone:304-733-4616
Mailing Address - Fax:304-733-4818
Practice Address - Street 1:99 CRACKER BARREL DR
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1622
Practice Address - Country:US
Practice Address - Phone:304-733-4616
Practice Address - Fax:304-733-4818
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000035643OtherMOUNTAIN STATE BC/BS
WV4401078OtherUNITED HEALTHCARE ID
WV92197OtherUNICARE ID
WV287658OtherMAMSI
WV9555595002OtherCIGNA
WV000000223716OtherANTHEM BC/BS
WV287658OtherOPTIMIUM CHOICE ID
WV0131767000Medicaid
WV1059296OtherWV WORKERS COMPENSATION
WV4342024OtherAETNA
WV350047718OtherRAILROAD MEDICARE