Provider Demographics
NPI:1891972725
Name:FALLING WATERS HEALING SPA, INC.
Entity Type:Organization
Organization Name:FALLING WATERS HEALING SPA, INC.
Other - Org Name:STEPHEN M. SHAW, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LUND
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-329-2888
Mailing Address - Street 1:1885 S ARLINGTON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3310
Mailing Address - Country:US
Mailing Address - Phone:775-329-2888
Mailing Address - Fax:775-329-2971
Practice Address - Street 1:1885 S ARLINGTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3310
Practice Address - Country:US
Practice Address - Phone:775-329-2888
Practice Address - Fax:775-329-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherFEDERAL TAX ID