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General NPI Number Information
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NPI Number | 1437171741
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Entity Type | Individual
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Provider Name | DOUGLAS E SHAW DC
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 515 W 14TH ST SUITE A
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4059
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Country | US
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Telephone | 231-941-5010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 904
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City | ANNA MARIA
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State | FL
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Zip | 34216-0904
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Country | US
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Telephone | 231-632-4380
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Fax |
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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 | DS004118
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License Number State | MI
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