Provider Demographics
NPI:1972659415
Name:SHAW CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SHAW CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:509-962-9633
Mailing Address - Street 1:305 N ANDERSON
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3361
Mailing Address - Country:US
Mailing Address - Phone:509-962-9633
Mailing Address - Fax:509-962-9634
Practice Address - Street 1:305 N ANDERSON
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3361
Practice Address - Country:US
Practice Address - Phone:509-962-9633
Practice Address - Fax:509-962-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013902Medicaid
WA0015384OtherLAND I
WA66425964OtherGROUP HEALTH
T02502Medicare UPIN