Provider Demographics
NPI:1922180272
Name:ANDERSON-SHAW CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ANDERSON-SHAW CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON-SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-443-2225
Mailing Address - Street 1:78 FOREST PARK PLZ
Mailing Address - Street 2:P.O. BOX 481
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2737
Mailing Address - Country:US
Mailing Address - Phone:812-443-2225
Mailing Address - Fax:812-443-2226
Practice Address - Street 1:78 FOREST PARK PLZ
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2737
Practice Address - Country:US
Practice Address - Phone:812-443-2225
Practice Address - Fax:812-443-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200382620Medicaid
IN200382620Medicaid