MEDICARE: DAVID W SHAW DC PA

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	CHOOO4544	FL

General Provider Information

NPI Number	:	1083895387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID W SHAW DC PA

Provider Business Mailing Address
First Line	:	1006 VIRGINIA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3522
Country	:	US
Telephone Number	:	772-466-5600
Fax Number	:	772-466-1652

Provider Business Practice Location Address
First Line	:	1006 VIRGINIA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3522
Country	:	US
Telephone Number	:	772-466-5600
Fax Number	:	772-466-1652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID W SHAW
Credential	:
Telephone Number	:	772-466-5600

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/30/2007

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