Individual provider Active NPI

Shannon Kaufman, D.C.

  • Chiropractor
  • Seattle, WA
National Provider Identifier
1104280650
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH60631494 Issued in WA
Practice address
557 Roy St
Suite 100
Seattle, WA 98109-4219
Phone
(206) 285-1068
NPI assigned
Apr 11, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH60631494 WA Primary

Addresses

Primary practice location

557 Roy St
Suite 100
Seattle, WA 98109-4219

Mailing address

557 Roy St
Suite 100
Seattle, WA 98109-4219
Phone (206) 285-1068

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160718002287 WA Practitioner - Chiropractic 9739472457 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH60631494WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Corbin Chiropractic Clinic PLLC Chiropractor CurrentSince Jun 10, 2016 Accepting new patients

Locations

4608 NE 4th St
Renton, WA 98059
Phone (425) 226-6261

Organizations & group practices 1

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": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1104280650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 ROY ST",
            "address_2": "SUITE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094219",
            "telephone_number": "206-285-1068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 ROY ST",
            "address_2": "SUITE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981094219",
            "telephone_number": "206-285-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-11",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60631494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.