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General NPI Number Information
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NPI Number | 1083895387
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Entity Type | Organization
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Legal Business Name | DAVID W SHAW DC PA
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 1006 VIRGINIA AVE
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City | FORT PIERCE
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State | FL
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Zip | 34982-3522
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Country | US
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Telephone | 772-466-5600
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Fax | 772-466-1652
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Provider Business Mailing Address
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Address Line | 1006 VIRGINIA AVE
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City | FORT PIERCE
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State | FL
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Zip | 34982-3522
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Country | US
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Telephone | 772-466-5600
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Fax | 772-466-1652
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID W SHAW
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Credential |
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Telephone | 772-466-5600
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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 | CHOOO4544
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License Number State | FL
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