Brad Alan Shallow, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH11338 Issued in FL

Practice address

120 S Woodland Blvd
Suite B
Deland, FL 32720-5445

Phone

(386) 341-1404

NPI assigned

Jan 24, 2015

Last updated

Jan 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chiropractic Connection LLC

  • Chiropractor
  • Deland, FL
  • NPI 1073903399
  Authorized official Same address or phone

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

{
    "created_epoch": "1422057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422057600000",
    "number": "1447640768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 TALL PINE DR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274828",
            "telephone_number": "910-231-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S WOODLAND BLVD",
            "address_2": "SUITE B",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327205445",
            "telephone_number": "386-341-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHALLOW",
        "first_name": "BRAD",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-24",
        "last_updated": "2015-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH11338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Deland, FL
• Providers in Deland, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2015; 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.