Provider Demographics
NPI:1366560328
Name:SHETLER, JEFFREY L (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:SHETLER
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:717-263-2655
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:717-263-2655
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101625780 0001Medicaid
PA411492OtherUPMC HEALTH PLAN
PA001582032OtherHIGHMARK BC BS