Provider Demographics
NPI:1023000155
Name:SHAW, TERRY W (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
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 1:3701 E LAKE CTR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5842
Mailing Address - Country:US
Mailing Address - Phone:217-224-3935
Mailing Address - Fax:217-224-5941
Practice Address - Street 1:3701 E LAKE CTR
Practice Address - Street 2:SUITE 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5842
Practice Address - Country:US
Practice Address - Phone:217-224-3935
Practice Address - Fax:217-224-5941
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38003395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178343OtherHEALTHLINK NUMBER
ILL73078Medicare PIN