Provider Demographics
NPI:1861543357
Name:SHEALER, BRENT WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WILLIAM
Last Name:SHEALER
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 1:400 PENN CENTER BLVD
Mailing Address - Street 2:STE 637
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5613
Mailing Address - Country:US
Mailing Address - Phone:412-823-5710
Mailing Address - Fax:412-823-5709
Practice Address - Street 1:4303 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2807
Practice Address - Country:US
Practice Address - Phone:412-823-5710
Practice Address - Fax:412-823-5709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU89063Medicare UPIN
PA054619Medicare ID - Type Unspecified