Provider Demographics
NPI:1659570893
Name:SHAW, KEVIN D (ND , LAC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:SHAW
Suffix:
Gender:M
Credentials:ND , LAC
Other - Prefix:
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Mailing Address - Street 1:2804 GRAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3430
Mailing Address - Country:US
Mailing Address - Phone:425-258-4633
Mailing Address - Fax:425-258-4644
Practice Address - Street 1:2804 GRAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3430
Practice Address - Country:US
Practice Address - Phone:425-258-4633
Practice Address - Fax:425-258-4644
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC2968171100000X
WANT1544175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist