Provider Demographics
NPI:1598820649
Name:SHAW, ANDREA LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYN
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 1:143 THOMAS ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5231
Mailing Address - Country:US
Mailing Address - Phone:360-302-6285
Mailing Address - Fax:360-368-3989
Practice Address - Street 1:143 THOMAS ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5231
Practice Address - Country:US
Practice Address - Phone:360-302-6285
Practice Address - Fax:360-368-3989
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215506OtherDEPT OF LABOR&INDUSTRIES