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General NPI Number Information
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NPI Number | 1053558775
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Entity Type | Individual
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Provider Name | PHILLIP JAMES SHAW D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 41 HUNTINGTON LN
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City | WHEELING
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State | IL
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Zip | 60090-6908
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Country | US
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Telephone | 847-850-7740
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Fax | 847-850-7745
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Provider Business Mailing Address
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Address Line | 2625 BUTTERFIELD RD STE 301N
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City | OAK BROOK
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State | IL
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Zip | 60523-1234
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Country | US
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Telephone | 630-320-6400
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Fax | 630-701-1007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011339
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License Number State | IL
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