Provider Demographics
NPI:1003955964
Name:SHAW, JEFFREY W (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
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:PO BOX 36
Mailing Address - Street 2:60 2ND ST
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-0036
Mailing Address - Country:US
Mailing Address - Phone:970-887-3131
Mailing Address - Fax:970-887-3913
Practice Address - Street 1:60 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-0036
Practice Address - Country:US
Practice Address - Phone:970-887-3131
Practice Address - Fax:970-887-3913
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
453188Medicare ID - Type Unspecified
T60504Medicare UPIN