MEDICARE: CORY SHAW L.AC.

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	171100000X	Acupuncturist	00750	TX

General Provider Information

NPI Number	:	1407981244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY SHAW L.AC.

Provider Business Mailing Address
First Line	:	7300 BLANCO RD
Second Line	:	SUITE 503
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 BLANCO RD
Second Line	:	SUITE 503
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4936
Country	:	US
Telephone Number	:	210-733-0990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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Directions to “ CORY SHAW L.AC.” Practice Location

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