Shane Pitman Kelly, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC34126 Issued in CA

Practice address

10803 Vista Sorrento Pkwy
San Diego, CA 92121-2792

Phone

(197) 773-0196

NPI assigned

Feb 4, 2018

Last updated

Aug 16, 2019By 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 CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Healcove, a Johnson Pontillas Chiropractic and Wellness PC

  • Chiropractor
  • San Diego, CA
  • NPI 1649971607
  Medicare reassignment NPD
• Shane Kelly, D.C., LLC

  • Chiropractor
  • San Diego, CA
  • NPI 1710533591
  Authorized official Same address or phone
• Amy Oldendorf

  • Massage Therapist
  • Portland, OR
  • NPI 1144770645

  Single Specialty

  NPD (past)
• Michelle Reynolds

  • Acupuncturist
  • Portland, OR
  • NPI 1851558217

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1517702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1710486832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10803 VISTA SORRENTO PKWY STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212792",
            "telephone_number": "619-777-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10803 VISTA SORRENTO PKWY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212792",
            "telephone_number": "197-773-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHANE",
        "middle_name": "PITMAN",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-04",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC34126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "DC34126",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Kelly, L.AC
• Panteha Dowlatshahi Kelly, RPH
• Rachel Kelly
• Rachel Helen Kelly, PA-C
• Sarah Kathryn Quinn Kelly
• Taylor Kelly
• Thomas F Kelly, M.D.
• Thomas Gerald Kelly, M.D.
• Tyler Kelly
• Valerie Jean Kelly, M. A. CCC-SLP

• Chiropractor in San Diego, CA
• Providers in San Diego, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.