Provider Demographics
NPI:1124116447
Name:SHAW, RICHARD A (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8132
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-8132
Mailing Address - Country:US
Mailing Address - Phone:740-450-9000
Mailing Address - Fax:
Practice Address - Street 1:1400 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1083
Practice Address - Country:US
Practice Address - Phone:740-450-9000
Practice Address - Fax:740-450-2494
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0994107Medicaid
OHV08051Medicare UPIN
OHSH4176761Medicare PIN