Provider Demographics
NPI:1316942147
Name:SHOEMAKER, JAMES LEO (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEO
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205/206 HIGHPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525
Mailing Address - Country:US
Mailing Address - Phone:985-710-2644
Mailing Address - Fax:
Practice Address - Street 1:1013B WEST JUDGE PEREZ DRIVE
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043
Practice Address - Country:US
Practice Address - Phone:504-271-6500
Practice Address - Fax:504-279-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA684111NR0200X, 111NR0400X, 111NS0005X, 111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6417817OtherCIGNA
KY66307OtherOFFICE OF GROUP BENEFITS
LA59660OtherINDIVIDUAL
LA692818OtherAETNA
LAN173011OtherFARA WORKERS COMP
LA721153266OtherDEFINITY HEALTHCARE
LA59660OtherINDIVIDUAL
LA721153266OtherDEFINITY HEALTHCARE
KY66307OtherOFFICE OF GROUP BENEFITS