Provider Demographics
NPI:1497703052
Name:ANDERSON-SHAW, JULIE K (DC)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:K
Last Name:ANDERSON-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 1:78 FOREST PARK PLZ
Mailing Address - Street 2:P.O. BOX 481
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2737
Mailing Address - Country:US
Mailing Address - Phone:812-443-2225
Mailing Address - Fax:812-443-2226
Practice Address - Street 1:78 FOREST PARK PLZ
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2737
Practice Address - Country:US
Practice Address - Phone:812-443-2225
Practice Address - Fax:812-443-2226
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200072290Medicaid
INU57576Medicare UPIN
IN133030AMedicare PIN