MEDICARE: DR. CHARLES NEAL SHAW D.C., M.S.

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	70 011806	NY

General Provider Information

NPI Number	:	1134456924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES NEAL SHAW D.C., M.S.

Provider Business Mailing Address
First Line	:	110 HAMPDEN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 HAMPDEN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1036
Country	:	US
Telephone Number	:	315-638-0917
Fax Number	:

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

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	12/30/2009

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