Provider Demographics
NPI:1831218684
Name:SHAW, THOMAS D (DC)
Entity type:Individual
Prefix:MS
First Name:THOMAS
Middle Name:D
Last Name:SHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:A-10
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3673
Mailing Address - Country:US
Mailing Address - Phone:410-313-8325
Mailing Address - Fax:410-313-9755
Practice Address - Street 1:10045 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:A-10
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3673
Practice Address - Country:US
Practice Address - Phone:410-313-8325
Practice Address - Fax:410-313-9755
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS1501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM768Medicare ID - Type Unspecified