Healthcare Provider Details

I. General information

NPI: 1407981244
Provider Name (Legal Business Name): CORY SHAW L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BLANCO RD SUITE 503
SAN ANTONIO TX
78216-4936
US

IV. Provider business mailing address

7300 BLANCO RD SUITE 503
SAN ANTONIO TX
78216-4936
US

V. Phone/Fax

Practice location:
  • Phone: 210-733-0990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number00750
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: