Provider Demographics
NPI:1083734727
Name:SHAW, JILL BALLA (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:BALLA
Last Name:SHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38377 N DREXEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-9778
Mailing Address - Country:US
Mailing Address - Phone:847-838-2611
Mailing Address - Fax:847-838-2623
Practice Address - Street 1:38377 N DREXEL BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-9778
Practice Address - Country:US
Practice Address - Phone:847-838-2611
Practice Address - Fax:847-838-2623
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009331111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor