Provider Demographics
NPI:1265503577
Name:SHAW, NOEL L (DC)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:L
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 1:1101 N WILMOT RD
Mailing Address - Street 2:#229
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5100
Mailing Address - Country:US
Mailing Address - Phone:520-721-9331
Mailing Address - Fax:520-721-0325
Practice Address - Street 1:1101 N WILMOT RD
Practice Address - Street 2:#229
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5100
Practice Address - Country:US
Practice Address - Phone:520-721-9331
Practice Address - Fax:520-721-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4092111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician