Active NPI
Shannon Peacock, DC
- Chiropractor
- Tahoe City, CA
National Provider Identifier
1952811895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 34034
- Practice address
- 645 West Lake Blvd. #3
PO Box 7526
Tahoe City, CA 96145-7526 - Phone
- (530) 583-7475
- Fax
- (530) 583-7477
- NPI assigned
- Oct 5, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 34034 | CA | Primary |
Addresses
Primary practice location
645 West Lake Blvd. #3
PO Box 7526
Tahoe City, CA 96145-7526
Mailing address
PO Box 492
Truckee, CA 96160
Phone (530) 448-6124
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 |
|---|---|---|---|
| 34034 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elemental Back & Body | Chiropractor | Past | Accepting new patients |
| Crone Chiropractic, PC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Tahoe City, CA
- NPI 1912466434
-
- Chiropractor
- Truckee, CA
- NPI 1477972362
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527724800000",
"number": "1952811895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 492",
"city": "TRUCKEE",
"state": "CA",
"postal_code": "96160",
"telephone_number": "530-448-6124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 WEST LAKE BLVD. #3",
"address_2": "PO BOX 7526",
"city": "TAHOE CITY",
"state": "CA",
"postal_code": "961457526",
"telephone_number": "530-583-7475",
"fax_number": "530-583-7477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "SHANNON",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-05",
"last_updated": "2018-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "34034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahoe City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.