Active NPI
Shanna Lynn Bissonette, D.C.
- Chiropractor
- Mammoth Lakes, CA
National Provider Identifier
1376664698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC 23101
- Practice address
- 272 Sierra Manor Rd
2B
Mammoth Lakes, CA 93546-0716 - Phone
- (760) 793-3895
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC 23101 | CA | Primary |
Addresses
Primary practice location
272 Sierra Manor Rd
2B
Mammoth Lakes, CA 93546-0716
Mailing address
PO Box 716
272 Sierra Manor Rd 2B
Mammoth Lakes, CA 93546-0716
Phone (760) 793-3895
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100303000907 | CA | Practitioner - Chiropractic | 3870638711 | Practice locations: Mammoth Lakes, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
272 Sierra Manor Rd
Suite 2B
Mammoth Lakes, CA 93546-0716
PO Box
Suite 716
Mammoth Lakes, CA 93546-0716
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC 23101 | CA | MD | Chiropractor |
| 23101 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332892800000",
"number": "1376664698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 716",
"address_2": "272 SIERRA MANOR RD 2B",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935460716",
"telephone_number": "760-793-3895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 SIERRA MANOR RD",
"address_2": "2B",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935460716",
"telephone_number": "760-793-3895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISSONETTE",
"first_name": "SHANNA",
"middle_name": "LYNN",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2012-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC 23101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mammoth Lakes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; 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.