Provider Demographics
NPI:1659595767
Name:SHAW, FREDDRICK DOUGLASS (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDDRICK
Middle Name:DOUGLASS
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 1:12905 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2005
Mailing Address - Country:US
Mailing Address - Phone:281-440-9794
Mailing Address - Fax:281-440-9799
Practice Address - Street 1:12905 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2005
Practice Address - Country:US
Practice Address - Phone:281-440-9794
Practice Address - Fax:281-440-9799
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor