Provider Demographics
NPI:1336207620
Name:SHAW, DAVID GARY (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
Last Name:SHAW
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15534 SANDFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9801
Mailing Address - Country:US
Mailing Address - Phone:407-851-0980
Mailing Address - Fax:407-851-0918
Practice Address - Street 1:1626 CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2705
Practice Address - Country:US
Practice Address - Phone:407-851-0980
Practice Address - Fax:407-851-0918
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6333111N00000X
FLCH7568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor