Shallow Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301004116 Issued in MI

Legal business name

SHALLOW CHIROPRACTIC PC

Practice address

24820 Michigan Ave
Dearborn, MI 48124-1713

Phone

(313) 277-3766

Fax

(313) 277-7196

NPI assigned

Aug 9, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Randy Joe Shallow, DCNPI 1609906866

Title

President/Director

Phone

(313) 277-3766

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randy Joe Shallow, CHIROPRACTIC

  • Chiropractor
  • Dearborn, MI
  • NPI 1609906866
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710988068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24820 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241713",
            "telephone_number": "313-277-3766",
            "fax_number": "313-277-7196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24820 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241713",
            "telephone_number": "313-277-3766",
            "fax_number": "313-277-7196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALLOW CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHALLOW",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "PRESIDENT/DIRECTOR",
        "authorized_official_telephone_number": "313-277-3766",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301004116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "RS004116",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dillon Shain
• Halimeh Musaid Shajira, R.PH
• Nadeah Shajira
• Fatima Shajrah
• Shaker Haddad MD PC
• Randy Joe Shallow, CHIROPRACTIC
• Adwaa Shamel
• Jenna Samer Shami
• Kifaya Shami
• Zackaria Saleh Shami

• Chiropractor in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.