Provider Demographics
NPI:1497221733
Name:SHAW, JO NELL MARIE (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:JO NELL
Middle Name:MARIE
Last Name:SHAW
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W. OAK ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524
Mailing Address - Country:US
Mailing Address - Phone:970-658-1281
Mailing Address - Fax:
Practice Address - Street 1:148 W. OAK ST
Practice Address - Street 2:SUITE C
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-658-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007843111N00000X
COND.0000190175F00000X
COCHR0007843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath