Provider Demographics
NPI:1760490619
Name:SHAW, DAVID G (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
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 1:18652 FLORIDA ST
Mailing Address - Street 2:STE 245
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1924
Mailing Address - Country:US
Mailing Address - Phone:714-698-3460
Mailing Address - Fax:714-698-3463
Practice Address - Street 1:18652 FLORIDA ST
Practice Address - Street 2:STE 245
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1924
Practice Address - Country:US
Practice Address - Phone:714-698-3460
Practice Address - Fax:714-698-3463
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26492Medicare ID - Type Unspecified