Individual provider Active NPI

Shannon Jay Score, DC

  • Chiropractor
  • Lakeville, MN
National Provider Identifier
1417976648
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
C2095 Issued in MN
Practice address
10551 165TH St W
Lakeville, MN 55044-5737
Phone
(952) 435-5300
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X C2095 MN Primary

Addresses

Primary practice location

10551 165TH St W
Lakeville, MN 55044-5737

Mailing address

10551 165TH St W
Lakeville, MN 55044-5737
Phone (952) 435-5300

Other identifiers 1

IdentifierTypeStateIssuer
88G89SCOtherFMBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060314000658 MN Practitioner - Chiropractic 3476560541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Wellness Center IncGroup PAC ID 3274584438, 4 clinicians

Practice addresses (Care Compare)

10551 165TH St W
Lakeville, MN 55044-5737
Phone (952) 435-5300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2095MNMDMarriage & Family Therapist
C2095MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Life Wellness Center, Inc. Chiropractor CurrentSince Apr 1, 2006 Accepting new patients

Locations

1895 Plaza Dr
Ste 200
Eagan, MN 55122
Phone (651) 688-8886

10551 165th St W
Lakeville, MN 55044
Phone (952) 435-5300

Organizations & group practices 1

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417976648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10551 165TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550445737",
            "telephone_number": "952-435-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10551 165TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550445737",
            "telephone_number": "952-435-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCORE",
        "first_name": "SHANNON",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "C2095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "88G89SC",
            "state": "FM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

  • 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.