Jessica Shannon, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6503 Issued in MN

Practice address

18466 Kenyon Ave
Lakeville, MN 55044-6911

Phone

(612) 470-3688

NPI assigned

Apr 25, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1174011167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9620 LIVERY LN",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18466 KENYON AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446911",
            "telephone_number": "612-470-3688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9620 Livery Ln",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550447128",
            "country_code": "US",
            "telephone_number": "651-387-7864",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18556 Pilot Knob Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MN",
            "postal_code": "550248679",
            "country_code": "US",
            "telephone_number": "651-387-7864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "JESSICA",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-25",
        "last_updated": "2022-12-23",
        "certification_date": "2020-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.