Provider Demographics
NPI:1780265512
Name:SHAW, THERESA A H (DC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A H
Last Name:SHAW
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PEAKWOOD DR STE 3E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2907
Mailing Address - Country:US
Mailing Address - Phone:281-984-9556
Mailing Address - Fax:
Practice Address - Street 1:18425 CHAMPION FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3999
Practice Address - Country:US
Practice Address - Phone:346-808-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14657OtherDC LICENSE NUMBER