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1235306119 NPI number — SHANNON ROBERTS D.C.

NPI Number: 1235306119
Health Care Provider/Practitioner: SHANNON ROBERTS D.C.

Information about “1235306119” NPI (SHANNON ROBERTS D.C.) exists in 1235306119 in HTML format HTML  |  1235306119 in plain Text format TXT  |  1235306119 in PDF (Portable Document Format) PDF  |  1235306119 in an XML format XML  formats.

NPI Number : 1235306119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235306119",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROBERTS",
    "FirstName": "SHANNON",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MODDEJONGE",
    "OtherFirstName": "SHANNON",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.C.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3786 S EAST ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46227-1241",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-791-1511",
    "MailingAddressFaxNumber": "317-791-1534",
    "FirstLinePracticeLocationAddress": "3786 S EAST ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46227-1241",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-791-1511",
    "PracticeLocationAddressFaxNumber": "317-791-1534",
    "EnumerationDate": "05/10/2008",
    "LastUpdateDate": "07/29/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "10800",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "08002519A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "3943",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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