MEDICARE: DR. JAMES LEO SHOEMAKER DC, CCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	684	LA
2	111NR0400X	Rehabilitation Chiropractor	684	LA
3	111NS0005X	Sports Physician Chiropractor	684	LA
4	111NX0800X	Orthopedic Chiropractor	684	LA
5	111N00000X	Chiropractor	684	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6417817	OTHER	LA	CIGNA
2	66307	OTHER	KY	OFFICE OF GROUP BENEFITS
3	59660	OTHER	LA	INDIVIDUAL
4	692818	OTHER	LA	AETNA
5	N173011	OTHER	LA	FARA WORKERS COMP
6	721153266	OTHER	LA	DEFINITY HEALTHCARE

General Provider Information

NPI Number	:	1316942147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LEO SHOEMAKER DC, CCSP

Provider Business Mailing Address
First Line	:	205/206 HIGHPOINT DRIVE
Second Line	:
City	:	DIAMONDHEAD
State	:	MS
Zip	:	39525
Country	:	US
Telephone Number	:	985-710-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013B WEST JUDGE PEREZ DRIVE
Second Line	:
City	:	CHALMETTE
State	:	LA
Zip	:	70043
Country	:	US
Telephone Number	:	504-271-6500
Fax Number	:	504-279-7778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/11/2022

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