Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1596 | CO |
NPI | 1003955964 |
---|---|
Provider Name | Dr. Jeffrey W Shaw |
First Address | Granby, CO 80446-0036 |
Second Address | Granby, CO 80446-0036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T60504 | (02) |