Provider Demographics
NPI:1891925202
Name:STEVEN SHAW CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:STEVEN SHAW CHIROPRACTIC INC.
Other - Org Name:ELEMENT LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-219-2600
Mailing Address - Street 1:627 W. ARDEN AVE.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2856
Mailing Address - Country:US
Mailing Address - Phone:818-219-2600
Mailing Address - Fax:
Practice Address - Street 1:265 E. ORANGE GROVE AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1229
Practice Address - Country:US
Practice Address - Phone:818-556-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty