Provider Demographics
NPI:1609979863
Name:SHAW, MICHAEL M
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CARLISLE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204
Mailing Address - Country:US
Mailing Address - Phone:214-754-0700
Mailing Address - Fax:214-754-0703
Practice Address - Street 1:3000 CARLISLE
Practice Address - Street 2:SUITE 206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204
Practice Address - Country:US
Practice Address - Phone:214-754-0700
Practice Address - Fax:214-754-0703
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
611736Medicare ID - Type Unspecified