Jeff Holzworth Shaffer, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2905 Issued in NC

Practice address

3960 Executive Park Blvd Ste 5
Southport, NC 28461-8184

Phone

(910) 454-8100

Fax

(910) 454-8101

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1992766562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3960 EXECUTIVE PARK BLVD STE 5",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618184",
            "telephone_number": "910-454-8100",
            "fax_number": "910-454-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 EXECUTIVE PARK BLVD STE 5",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618184",
            "telephone_number": "910-454-8100",
            "fax_number": "910-454-8101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "412 N Howe St",
            "address_purpose": "LOCATION",
            "city": "Southport",
            "state": "NC",
            "postal_code": "284613400",
            "country_code": "US",
            "telephone_number": "910-454-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "JEFF",
        "middle_name": "HOLZWORTH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085AY",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Southport, NC
• Providers in Southport, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.