Provider Demographics
NPI:1336467752
Name:D SHAW CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:D SHAW CHIROPRACTIC PLLC
Other - Org Name:SHAW CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-941-5010
Mailing Address - Street 1:515 W 14TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4059
Mailing Address - Country:US
Mailing Address - Phone:231-941-5010
Mailing Address - Fax:231-941-2007
Practice Address - Street 1:515 W 14TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4059
Practice Address - Country:US
Practice Address - Phone:231-941-5010
Practice Address - Fax:231-941-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B85013Medicare UPIN