Shawn Lutz DC LLC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

4064 Issued in OR

Legal business name

SHAWN LUTZ DC LLC

Practice address

296 SW Columbia St Ste D1
Bend, OR 97702-1020

Phone

(541) 600-2558

Fax

(541) 833-0562

NPI assigned

Feb 20, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Shawn Conrad Lutz, DCNPI 1093012999

Title

Owner

Phone

(458) 206-6123

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dynamic Sports Rehab Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Conrad Lutz, D.C.

  • Sports Physician Chiropractor
  • Bend, OR
  • NPI 1093012999
  Medicare reassignment Care Compare group Authorized official
• Macy Earl, DC

  • Chiropractor
  • Bend, OR
  • NPI 1154173094
  Medicare reassignment Care Compare group NPD
• Joseph Matthew Farris, D.C.

  • Chiropractor
  • Bend, OR
  • NPI 1770953085
  Medicare reassignment Care Compare group NPD
• Taylor Xavier Owens, DC

  • Chiropractor
  • Vancouver, WA
  • NPI 1265076632

  OR

  Medicare reassignment NPD

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1962902403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 SW COLUMBIA ST STE D1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021020",
            "telephone_number": "541-600-2558",
            "fax_number": "541-833-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 SW COLUMBIA ST STE D1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021020",
            "telephone_number": "541-600-2558",
            "fax_number": "541-833-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWN LUTZ DC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "LUTZ",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "CONRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "458-206-6123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "4064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1093012999",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dynamic Sports Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Divya Sharma, MD
• Sharon Richards, LCSW
• Robin Sharpe
• Kevin Shaw, LCSW, CADC III
• Madison Kristin Shaw
• Michelle Louise Shawver, PSY.D.
• Laura Shea
• Rita Marie Shearer, RN CDE
• Kamer Sheeter, LMT
• Linda Shekerdemian, M.ED. L.P.C.

• Sports Physician Chiropractor in Bend, OR
• Providers in Bend, OR by specialty
• Sports Physician Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.