Provider Demographics
NPI:1821228081
Name:SHAW, STEPHEN WALTER (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WALTER
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:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42719-0546
Mailing Address - Country:US
Mailing Address - Phone:270-465-5651
Mailing Address - Fax:270-469-4600
Practice Address - Street 1:1900 GREENSBURG RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8448
Practice Address - Country:US
Practice Address - Phone:270-465-5651
Practice Address - Fax:270-469-4600
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor