Healthcare Provider Details

I. General information

NPI: 1366171654
Provider Name (Legal Business Name): SHAW FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W OAK ST STE C
FORT COLLINS CO
80524-2893
US

IV. Provider business mailing address

148 W OAK ST STE C
FORT COLLINS CO
80524-2893
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-1281
  • Fax: 970-844-8884
Mailing address:
  • Phone: 970-658-1281
  • Fax: 970-844-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. JO NELL M SHAW
Title or Position: CEO, CHIEF CLINICIAN
Credential: DC, ND
Phone: 970-658-1281