Provider Demographics
NPI:1215901806
Name:SHAW, CHAD P (DC)
Entity type:Individual
Prefix:MISS
First Name:CHAD
Middle Name:P
Last Name:SHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:8705 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6344
Mailing Address - Country:US
Mailing Address - Phone:904-725-2286
Mailing Address - Fax:904-725-4566
Practice Address - Street 1:8705 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6344
Practice Address - Country:US
Practice Address - Phone:904-997-1349
Practice Address - Fax:904-997-1369
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH8022OtherCHIROPRACTIC LICENSE
FLU88716Medicare UPIN
FLE6887ZMedicare ID - Type Unspecified