Shoal Creek Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2005026319 Issued in MO

Legal business name

SHOAL CREEK CHIROPRACTIC PC

Practice address

11105 N Booth Ave
Kansas City, MO 64157-9205

Phone

(660) 322-0641

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Sean Dunivent, D.C.NPI 1619026275

Title

Owner

Phone

(660) 322-0641

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sean Matthew Dunivent, D.C.

  • Chiropractor
  • Kansas City, MO
  • NPI 1619026275
  Medicare reassignment NPD Authorized official
• Bryna M Miller, D.C.

  • Chiropractor
  • Kansas City, MO
  • NPI 1366731408
  Medicare reassignment
• Renny Beau Russell, DC

  • Chiropractor
  • Pleasant Valley, MO
  • NPI 1003905456
  NPD (past)

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508992728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11105 N BOOTH AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641579205",
            "telephone_number": "660-322-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11105 N BOOTH AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641579205",
            "telephone_number": "660-322-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOAL CREEK CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUNIVENT",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-322-0641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2005026319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia M Shires, M.S.
• Frankie Shirley-Jones, CEO-RCMA
• Alison Shirley, RN
• Ladijah Imani Shivers, DDS
• Mariya Shkolnaya, MD
• Shoal Creek Dental Care LLC
• Shoal Creek Family Medicine and Allergy, PC
• Shoal Creek Pediatric Dentistry, L.L.C.
• Garrett Cole Shobe, PHARMD
• Cheryl Lynn Shockley

• Chiropractor in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.