Robert L Shackelford, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

998 Issued in AR

Practice address

219 SW Second St
Walnut Ridge, AR 72476-2335

Phone

(870) 886-2603

Fax

(870) 886-2623

NPI assigned

May 19, 2006

Last updated

Apr 25, 2014By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lawrence County Chiropractic Clinic, Inc.Group PAC ID 0840367751, 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.

• Lawrence County Chiropractic Clinic, Inc.

  • Chiropractor
  • Walnut Ridge, AR
  • NPI 1437227006
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398384000000",
    "number": "1568415362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 SW SECOND ST",
            "address_2": "PO BOX 896",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724762335",
            "telephone_number": "870-886-2603",
            "fax_number": "870-886-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 SW SECOND ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724762335",
            "telephone_number": "870-886-2603",
            "fax_number": "870-886-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "ROBERT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2014-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105133718",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Walnut Ridge, AR
• Providers in Walnut Ridge, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; 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.