Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 08001024 | IN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 08001024 | IN |
NPI | 1114017084 |
---|---|
Provider Name | Dr. G. Lyman Shaw |
First Address | Brownsburg, IN 46112-1947 |
Second Address | Brownsburg, IN 46112-1017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 04/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100133640 | (05) | IN |