Provider Demographics
NPI:1467772954
Name:SHAW, TREVOR THOMPSON
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:THOMPSON
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TREVOR
Other - Middle Name:THOMPSON
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1399 NO PONE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37336-4846
Mailing Address - Country:US
Mailing Address - Phone:386-366-2153
Mailing Address - Fax:423-728-6388
Practice Address - Street 1:1399 NO PONE VALLEY RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TN
Practice Address - Zip Code:37336-4846
Practice Address - Country:US
Practice Address - Phone:386-366-2153
Practice Address - Fax:423-728-6388
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor