Healthcare Provider Details

I. General information

NPI: 1144598699
Provider Name (Legal Business Name): SHAW CHIROPRACTIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W MAIN ST
NEW BRITAIN CT
06052-1315
US

IV. Provider business mailing address

136 W MAIN ST
NEW BRITAIN CT
06052-1315
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-4763
  • Fax: 860-826-4765
Mailing address:
  • Phone: 860-826-4763
  • Fax: 860-826-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN WAYNE SHAW
Title or Position: MEMBER
Credential: DC
Phone: 860-225-7429