Individual provider Active NPI

Shannon R Addleman, D.C.

  • Chiropractor
  • Oberlin, KS
National Provider Identifier
1477760239
Registry record updated Sep 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0105039 Issued in KS
Practice address
504 N Penn Ave
Oberlin, KS 67749-1619
Phone
(785) 475-2219
Fax
(785) 475-2210
NPI assigned
May 17, 2007
Last updated
Sep 26, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 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 0105039 KS Primary

Addresses

Primary practice location

504 N Penn Ave
Oberlin, KS 67749-1619

Mailing address

212 N Griffith Ave
Oberlin, KS 67749-1912
Phone (785) 475-2123

Other identifiers 1

IdentifierTypeStateIssuer
062407OtherKSBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070731000420 KS Practitioner - Chiropractic 7113028499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1998
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

504 N Penn Ave
Oberlin, KS 67749-1619

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0105039KSMDChiropractor

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190764800000",
    "number": "1477760239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N GRIFFITH AVE",
            "city": "OBERLIN",
            "state": "KS",
            "postal_code": "677491912",
            "telephone_number": "785-475-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 N PENN AVE",
            "city": "OBERLIN",
            "state": "KS",
            "postal_code": "677491619",
            "telephone_number": "785-475-2219",
            "fax_number": "785-475-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDLEMAN",
        "first_name": "SHANNON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KS",
            "license": "0105039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "062407",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oberlin, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.