NPIMap

Individual provider Active NPI

Shane Stuart Emmons, D.C.

  • Chiropractor
  • Minneapolis, MN
National Provider Identifier
1154631083
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5415 Issued in MN
Practice address
825 Hennepin Ave
Suite 216
Minneapolis, MN 55402-1802
Phone
(612) 333-9144
Fax
(612) 333-9144
NPI assigned
Oct 13, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5415 MN Primary

Addresses

Primary practice location

825 Hennepin Ave
Suite 216
Minneapolis, MN 55402-1802

Mailing address

825 Hennepin Ave
Suite 216
Minneapolis, MN 55402-1802
Phone (612) 333-9144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5415MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
IHS Regency PC Chiropractor PastSince Oct 1, 2010 Accepting new patients
IHS Midwest PC Chiropractor Past Accepting new patients

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": "1286928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1154631083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 HENNEPIN AVE",
            "address_2": "SUITE 216",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554021802",
            "telephone_number": "612-333-9144",
            "fax_number": "612-333-9144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 HENNEPIN AVE",
            "address_2": "SUITE 216",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554021802",
            "telephone_number": "612-333-9144",
            "fax_number": "612-333-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMMONS",
        "first_name": "SHANE",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-13",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.