MEDICARE: DR. TERRY W SHAW D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38003395	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178343	OTHER	IL	HEALTHLINK NUMBER

General Provider Information

NPI Number	:	1023000155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY W SHAW D.C.

Provider Business Mailing Address
First Line	:	3701 E LAKE CTR
Second Line	:	SUITE 1
City	:	QUINCY
State	:	IL
Zip	:	62305-5842
Country	:	US
Telephone Number	:	217-224-3935
Fax Number	:	217-224-5941

Provider Business Practice Location Address
First Line	:	3701 E LAKE CTR
Second Line	:	SUITE 1
City	:	QUINCY
State	:	IL
Zip	:	62305-5842
Country	:	US
Telephone Number	:	217-224-3935
Fax Number	:	217-224-5941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/10/2008

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