Provider Demographics
NPI:1518931849
Name:SHAW, ANDREA B (DC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:B
Last Name: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 1:8705 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6344
Mailing Address - Country:US
Mailing Address - Phone:904-997-1349
Mailing Address - Fax:904-997-1369
Practice Address - Street 1:8705 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6344
Practice Address - Country:US
Practice Address - Phone:904-997-1349
Practice Address - Fax:904-997-1369
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH8019OtherCHIROPRACTIC LICENSE
FLU88732Medicare UPIN
FLE6888ZMedicare ID - Type Unspecified