Provider Demographics
NPI:1710619143
Name:SHAW CHIROPRACTIC AND MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SHAW CHIROPRACTIC AND MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-447-5220
Mailing Address - Street 1:711 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2742
Mailing Address - Country:US
Mailing Address - Phone:615-447-5220
Mailing Address - Fax:615-447-5253
Practice Address - Street 1:711 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2742
Practice Address - Country:US
Practice Address - Phone:615-447-5220
Practice Address - Fax:615-447-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty