Provider Demographics
NPI:1427484211
Name:SHAW, BRET (DC)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:
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 1:1325 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4002
Mailing Address - Country:US
Mailing Address - Phone:785-320-2318
Mailing Address - Fax:785-320-2329
Practice Address - Street 1:1325 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4002
Practice Address - Country:US
Practice Address - Phone:785-320-2318
Practice Address - Fax:785-320-2329
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS01-05582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program