Provider Demographics
NPI:1891843058
Name:SHAW, CHALYSE H (DC)
Entity Type:Individual
Prefix:DR
First Name:CHALYSE
Middle Name:H
Last Name:SHAW
Suffix:
Gender:F
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 560
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:MD
Mailing Address - Zip Code:21111-0560
Mailing Address - Country:US
Mailing Address - Phone:410-357-4889
Mailing Address - Fax:410-357-4435
Practice Address - Street 1:17112 YORK RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9717
Practice Address - Country:US
Practice Address - Phone:410-357-4889
Practice Address - Fax:410-357-4435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01715PT111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD390546OtherMAMSI
MDR7290001OtherFEDERAL BLUECROSSSHIELD
MDM253CHOtherBLUECROSSBLUESHIELD
MDM253CHOtherBLUECROSSBLUESHIELD
MD390546OtherMAMSI