Healthcare Provider Details

I. General information

NPI: 1891925202
Provider Name (Legal Business Name): STEVEN SHAW CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E. ORANGE GROVE AVE. SUITE C
BURBANK CA
91502-1229
US

IV. Provider business mailing address

627 W. ARDEN AVE.
GLENDALE CA
91202-2856
US

V. Phone/Fax

Practice location:
  • Phone: 818-556-5433
  • Fax:
Mailing address:
  • Phone: 818-219-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-31188
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD STEVEN SHAW
Title or Position: PRESIDENT
Credential: D.C.
Phone: 818-219-2600