NPIMap

Organization Active NPI

Dynamic Performance Chiropractic of Hammond

  • Chiropractor
  • Hammond, LA
National Provider Identifier
1457850158
Registry record updated Feb 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
DYNAMIC PERFORMANCE CHIROPRACTIC OF HAMMOND
Practice address
1330 South Magnolia
Suite B
Hammond, LA 70403
Phone
(225) 402-0260
Fax
(225) 744-8201
NPI assigned
Feb 8, 2018
Last updated
Feb 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2018

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

Authorized official

Name
Matthew Shelly, D.C.NPI 1912142159
Title
Partner
Phone
(985) 400-1633

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X LA Primary

Addresses

Primary practice location

1330 South Magnolia
Suite B
Hammond, LA 70403

Mailing address

17557 Old Jefferson Hwy
Suite 102
Prairieville, LA 70769
Phone (225) 402-0260

Other names 1

  • MSDB Investments LLC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231218002951 LA Part B Supplier - Clinic/Group Practice 0547619413 Receives reassigned benefits from 1 practitioner
Practice locations: Hammond, LA

National Provider Directory

National Provider Directory

Locations

1330 S Magnolia St
Ste B
Hammond, LA 70403
Phone (225) 402-0260

17557 Old Jefferson Hwy
#102
Prairieville, LA 70769

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518393600000",
    "number": "1457850158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17557 OLD JEFFERSON HWY",
            "address_2": "SUITE 102",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "70769",
            "telephone_number": "225-402-0260",
            "fax_number": "225-744-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 SOUTH MAGNOLIA",
            "address_2": "SUITE B",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "70403",
            "telephone_number": "225-402-0260",
            "fax_number": "225-744-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PERFORMANCE CHIROPRACTIC OF HAMMOND",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-02-12",
        "status": "A",
        "authorized_official_last_name": "SHELLY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "985-400-1633",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSDB Investments LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hammond, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.