Active NPI
Shelly Ann Severns, DC
- Chiropractor
- O Fallon, IL
National Provider Identifier
1699062661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038.011937
- Practice address
- 635 W Highway 50
O Fallon, IL 62269-1941 - Phone
- (618) 624-3600
- NPI assigned
- Jun 28, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038.011937 | IL | Primary |
| Chiropractor | 111N00000X | 3641 | SC |
Addresses
Primary practice location
635 W Highway 50
O Fallon, IL 62269-1941
Mailing address
635 W Highway 50
O Fallon, IL 62269-1941
Phone (618) 624-3600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.011937 | IL | MD | Chiropractor |
| 3641 | SC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309219200000",
"number": "1699062661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 W HIGHWAY 50",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691941",
"telephone_number": "618-624-3600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 W HIGHWAY 50",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691941",
"telephone_number": "618-624-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEVERNS",
"first_name": "SHELLY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-28",
"last_updated": "2011-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038.011937",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "SC",
"license": "3641",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.