Provider Demographics
NPI:1609937838
Name:SHAW, DAVID W (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:SHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 VIRGINIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-3522
Mailing Address - Country:US
Mailing Address - Phone:772-466-5600
Mailing Address - Fax:772-466-1572
Practice Address - Street 1:1006 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-3522
Practice Address - Country:US
Practice Address - Phone:772-466-5600
Practice Address - Fax:772-466-1572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO4544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85427Medicare UPIN
FL70385Medicare PIN