Provider Demographics
NPI:1033421466
Name:SHAUB, MICHAEL CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:SHAUB
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 1:5512 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2576
Mailing Address - Country:US
Mailing Address - Phone:727-515-9944
Mailing Address - Fax:
Practice Address - Street 1:5512 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2576
Practice Address - Country:US
Practice Address - Phone:727-515-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor