Shepard Pain and Performance Care PC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

038011982 Issued in IL

Legal business name

SHEPARD PAIN AND PERFORMANCE CARE PC

Practice address

2 Airline Dr
Suite 400
Bloomington, IL 61704-3433

Phone

(815) 980-5706

NPI assigned

Jul 12, 2011

Last updated

Jul 12, 2011By 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

Dr. Matthew J Shepard, D.C.

Title

President

Phone

(815) 980-5706

Specialties & licenses 1

Addresses

Other names 1

• Shepard Pain and Performance Care PC Former legal business name

Locations

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310428800000",
    "number": "1922396928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 OAK CREEK PLZ APT 3-12",
            "address_2": "APT 3-12",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047545",
            "telephone_number": "815-980-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 AIRLINE DR",
            "address_2": "SUITE 400",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043433",
            "telephone_number": "815-980-5706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPARD PAIN AND PERFORMANCE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-12",
        "last_updated": "2011-07-12",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-980-5706",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "IL",
            "license": "038011982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shepard Pain and Performance Care PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Brooklyn Shaw
• Roger Allen Shaw, LMFT
• Rabia Sheikh
• Jennifer Dawn Sheler, APN
• Robin Bridgett Shelton
• Khyrstin Shepard
• Matthew J Shepard, D.C.
• Brianna Shepler, DC
• Krista J. Sheppard, DPT
• Sarah Lizet Shields, LSW

• Rehabilitation Chiropractor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Rehabilitation Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.