Shannon Gerald Watson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

441212 Issued in WI

Practice address

18103 Coastline Dr. #5
Malibu, CA 90265-5744

Phone

(310) 774-6772

Fax

(310) 752-6068

NPI assigned

Apr 22, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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 and National Provider Directory roles.

• Vital Force Chiropractic, Inc.

  • Chiropractor
  • Pacific Palisades, CA
  • NPI 1316113053
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238371200000",
    "number": "1639343585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18103 COASTLINE DR APT 5",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902655744",
            "telephone_number": "310-774-6772",
            "fax_number": "310-752-6068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18103 COASTLINE DR. #5",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902655744",
            "telephone_number": "310-774-6772",
            "fax_number": "310-752-6068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "SHANNON",
        "middle_name": "GERALD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-22",
        "last_updated": "2009-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "441212",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "31116",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent Pogo Health of NV PC
• Visions Treatment Centers, LLC
• Dimitri Vitebsky, LCSW
• Francine Vogler, M.D.
• Blaire Ann Christina Ward-Denson, MSC, DOCTORAL TRAINE
• Marion West
• Westside Sober Living Centers, Inc
• Westside Sober Living Centers, Inc.
• Jack Roger Williams, DDS
• Lorelei Elise Woerner-Eisner, OTR/L

• Chiropractor in Malibu, CA
• Providers in Malibu, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; 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.