Provider Demographics
NPI:1003937343
Name:SHAW, CONAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:CONAN
Middle Name:J
Last Name:SHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CHESTNUT GRV
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-2816
Mailing Address - Country:US
Mailing Address - Phone:412-663-0027
Mailing Address - Fax:
Practice Address - Street 1:325 THOMSON PARK DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6430
Practice Address - Country:US
Practice Address - Phone:724-778-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007254L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition