Shannon Michiyo Rudolph, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH9069 Issued in FL

Practice address

4400 NW 23Rd Ave
Gainesville, FL 32606-6580

Phone

(352) 371-4120

Fax

(352) 371-3378

NPI assigned

Jan 19, 2007

Last updated

Feb 24, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chiropractic Solutions of Gainesville IncGroup PAC ID 2264562586, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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 Solutions of Gainesville Inc

  • Chiropractor
  • Gainesville, FL
  • NPI 1386966885
  Medicare reassignment Care Compare group NPD Authorized official
• Helping Hands Chiropractic Center LC

  • Chiropractor
  • Gainesville, FL
  • NPI 1730240755
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487894400000",
    "number": "1548313711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 NW 43RD ST",
            "address_2": "STE 7B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326066632",
            "telephone_number": "352-872-5095",
            "fax_number": "352-872-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 NW 23RD AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326066580",
            "telephone_number": "352-371-4120",
            "fax_number": "352-371-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "SHANNON",
        "middle_name": "MICHIYO",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2017-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ilya Rud
• Lauren Anne Ruddocks, BDS
• Peter L. Rudnytsky, PH.D., LCSW
• Andrew David Rudolph, D.C.
• Dylan C Rudolph, MD
• Luis Jaime Rueda, D.D.S., M.S.D.
• Kyle W Ruffing, MD
• Andrea G Ruggieri, RN
• Christopher Ruggiero
• Iesha T Ruise-Pope

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; 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.