Individual provider Active NPI

Nicole Marie Shutko, D.C.

  • Rehabilitation Chiropractor
  • Houston, TX
National Provider Identifier
1083804355
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
8742 Issued in TX
Practice address
3910 Kirby Dr
Ste 212
Houston, TX 77098-4120
Phone
(713) 522-2886
Fax
(713) 522-2738
NPI assigned
Aug 1, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X 8742 TX Primary

Addresses

Primary practice location

3910 Kirby Dr
Ste 212
Houston, TX 77098-4120

Mailing address

3910 Kirby Dr
Ste 212
Houston, TX 77098-4120
Phone (713) 522-2886

Other identifiers 1

IdentifierTypeStateIssuer
8AK973OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250218003249 TX Practitioner - Chiropractic 0547780751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2040 N Loop W
Suite 103a
Houston, TX 77018-8157
Phone (713) 522-2886

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pe Health Choice Rehabilitation Center PA Rehabilitation CurrentSince Jan 13, 2025 Accepting new patients
City Center Chiropractic Past Accepting new patients

Locations

2040 North Loop W
Ste 103A
Houston, TX 77018
Phone (713) 522-2886

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1083804355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 KIRBY DR",
            "address_2": "STE 212",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770984120",
            "telephone_number": "713-522-2886",
            "fax_number": "713-522-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 KIRBY DR",
            "address_2": "STE 212",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770984120",
            "telephone_number": "713-522-2886",
            "fax_number": "713-522-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTKO",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-01",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "TX",
            "license": "8742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8AK973",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.