Shawn James McDermott, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0060001016 Issued in VT

Practice address

86 Dylan Dr
Suite 1
Randolph, VT 05060-9619

Phone

(802) 728-5159

Fax

(802) 728-5199

NPI assigned

Aug 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Randolph Chiropractic Associates LLC

  • Chiropractor
  • Randolph, VT
  • NPI 1700282662
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221436800000",
    "number": "1346357852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 DYLAN DR",
            "address_2": "SUITE 1",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050609619",
            "telephone_number": "802-728-5159",
            "fax_number": "802-728-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 DYLAN DR",
            "address_2": "SUITE 1",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050609619",
            "telephone_number": "802-728-5159",
            "fax_number": "802-728-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDERMOTT",
        "first_name": "SHAWN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VT",
            "license": "0060001016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN1716",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHEILD VT",
            "identifier": "38057",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taryn L Mason
• David Mathies, APRN
• Maxi Green Inc
• Hillary McAllister Bove, MSW
• Christian McCrory, MA
• Mindy McKenna Cayer, AA
• Eric C Medved, P.T.
• Brigid Joanna Meehan-Brese
• Amber Menard, BS
• Lucy Merriam, MD

• Chiropractor in Randolph, VT
• Providers in Randolph, VT by specialty
• Chiropractor in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; 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.