Provider Demographics
NPI:1629184759
Name:SHAW, SCOTT WARREN (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WARREN
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 1:10486 RIDGEFIELD PKWAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233
Mailing Address - Country:US
Mailing Address - Phone:801-741-3068
Mailing Address - Fax:772-619-3151
Practice Address - Street 1:10486 RIDGEFIELD PKWAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:801-741-3068
Practice Address - Fax:772-619-3151
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA068270OtherANTHEM BCBS
VA4400229OtherUNITED HEALTHCARE
VA010039746Medicaid
VA3500352501OtherRAILROAD MEDICARE
VA4546701OtherAETNA
VA4400229OtherUNITED HEALTHCARE
VA068270OtherANTHEM BCBS