Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 684 | LA |
N | 111NR0200X | Radiology | 684 | LA |
N | 213ER0200X | Radiology | 684 | LA |
N | 111NR0400X | Rehabilitation Chiropractor | 684 | LA |
N | 111NS0005X | Chiropractic Sports Physician | 684 | LA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 684 | LA |
NPI | 1316942147 |
---|---|
Provider Name | Dr. James Leo Shoemaker |
First Address | Chalmette, LA 70044-0901 |
Second Address | Chalmette, LA 70043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1937274 | (05) | LA |
2341A | BLUE CROSS PROVIDER # (01) | LA |
59660 | INDIVIDUAL (01) | LA |
6417817 | CIGNA (01) | LA |
66307 | OFFICE OF GROUP BENEFITS (01) | KY |
692818 | AETNA (01) | LA |
N173011 | FARA WORKERS COMP (01) | LA |
T84955 | (02) |