Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4092 | AZ |
NPI | 1265503577 |
---|---|
Provider Name | Dr. Noel L Shaw |
First Address | Tucson, AZ 85712-5100 |
Second Address | Tucson, AZ 85712-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |