Shannon Peterson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3809-012 Issued in WI

Practice address

N275 Military Rd
Suite 2
Sherwood, WI 54169-9603

Phone

(920) 989-1599

Fax

(920) 989-1593

NPI assigned

Jun 28, 2006

Sex

Female

Sole proprietor

No

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.

• Sherwood Chiropractic SC

  • Chiropractor
  • Sherwood, WI
  • NPI 1396812905
  Medicare reassignment NPD Authorized official

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316975683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N275 MILITARY RD",
            "address_2": "SUITE 2",
            "city": "SHERWOOD",
            "state": "WI",
            "postal_code": "541699603",
            "telephone_number": "920-989-1599",
            "fax_number": "920-989-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N275 MILITARY RD",
            "address_2": "SUITE 2",
            "city": "SHERWOOD",
            "state": "WI",
            "postal_code": "541699603",
            "telephone_number": "920-989-1599",
            "fax_number": "920-989-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3809-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38937000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina Gray-Siebers, LPC
• Gwen Annette Jellish, LPN
• Stephen M Kelly
• Deborah Rhea Malinowski, RN
• Christine Mary Matthias, COTA
• Daniel Lee Preissner
• Sidney B. Schulz, D.D.S.
• Sherwood Chiropractic SC
• Sherwood Dental S.C.
• Emma Weiblen

• All providers in Sherwood, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.