Organization Active NPI

Shepherd Chiropractic PLLC

  • Sports Physician Chiropractor
  • Le Claire, IA
National Provider Identifier
1104565571
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
Legal business name
SHEPHERD CHIROPRACTIC PLLC
Practice address
700 Eagle Ridge Rd
Le Claire, IA 52753-9593
Phone
(563) 289-3242
Fax
(563) 289-4541
NPI assigned
Jun 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Authorized official

Name
Dr. Ronald Shepherd, D.C. DACBSPNPI 1912901463
Title
Doctor
Phone
(563) 289-3242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NS0005X Primary

Addresses

Primary practice location

700 Eagle Ridge Rd
Le Claire, IA 52753-9593

Mailing address

700 Eagle Ridge Rd
Le Claire, IA 52753-9593
Phone (563) 289-3242

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220725000881 IA Part B Supplier - Clinic/Group Practice 0446631337 Receives reassigned benefits from 1 practitioner
Practice locations: Le Claire, IA

National Provider Directory

National Provider Directory

Locations

5123 Middle Rd
Ste 110
Bettendorf, IA 52722

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654128000000",
    "number": "1104565571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 EAGLE RIDGE RD",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "527539593",
            "telephone_number": "563-289-3242",
            "fax_number": "563-289-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 EAGLE RIDGE RD",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "527539593",
            "telephone_number": "563-289-3242",
            "fax_number": "563-289-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERD CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-02",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "563-289-3242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C. DACBSP"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Le Claire, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.