MEDICARE: JAKLL & SHAW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1013731322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAKLL & SHAW LLC

Provider Business Mailing Address
First Line	:	12211 KNOBCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-2437
Country	:	US
Telephone Number	:	720-308-5419
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PEAKWOOD DR STE 3E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2907
Country	:	US
Telephone Number	:	281-984-9556
Fax Number	:	281-984-9557

Authorized Official
Title or Position	:	OWNER
Name	:	THERESA SHAW
Credential	:	DC
Telephone Number	:	720-308-5419

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	01/09/2025

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Directions to “JAKLL & SHAW LLC ” Practice Location

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