Provider Demographics
NPI:1942334222
Name:SHAW, SUZANNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:THEMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:362 BOARDMAN-POLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-0000
Mailing Address - Country:US
Mailing Address - Phone:330-629-2121
Mailing Address - Fax:330-629-2323
Practice Address - Street 1:362 BOARDMAN-POLAND ROAD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4934
Practice Address - Country:US
Practice Address - Phone:330-629-2121
Practice Address - Fax:330-629-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11384840OtherCAQH
OH11384840OtherCAQH