Sports & Family Chiropractic LTD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0060001123 Issued in VT

Legal business name

SPORTS & FAMILY CHIROPRACTIC LTD

Practice address

65 S Main St
Suite 2
Waterbury, VT 05676-1550

Phone

(802) 244-1365

Fax

(802) 244-0840

NPI assigned

Nov 2, 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. Keith Heim SchallerNPI 1497824452

Title

Owner Chiropractor

Phone

(802) 244-1365

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VT

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.

• Keith Heinz Schaller, D.C.

  • Sports Physician Chiropractor
  • Waterbury, VT
  • NPI 1497824452
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932190584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 S MAIN ST",
            "address_2": "SUITE 2",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761550",
            "telephone_number": "802-244-1365",
            "fax_number": "802-244-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 S MAIN ST",
            "address_2": "SUITE 2",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761550",
            "telephone_number": "802-244-1365",
            "fax_number": "802-244-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS & FAMILY CHIROPRACTIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHALLER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "HEIM",
        "authorized_official_title_or_position": "OWNER CHIROPRACTOR",
        "authorized_official_telephone_number": "802-244-1365",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VT",
            "license": "0060001123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN3711",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "68628",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "67513",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaws Supermarkets Inc (Shaws Pharmacy #0649)
• Heather Amber Shlosser, FNP
• Thomas A Simpatico, M.D.
• Gillian Lee Skovron, LICSW
• Chloe Smith, LICSW
• State of Vermont (Vermont State Hospital)
• State of Vermont - Department for Children & Families
• State of Vermont Disability Determination Services
• Navah S Stein
• Jeanne D Stern, MS CCC-SLP

• Chiropractor in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Chiropractor in Vermont

• 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.