Provider Demographics
NPI:1528761400
Name:SHAW, DAVID PHILLIP JR (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PHILLIP
Last Name:SHAW
Suffix:JR
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 1:2638 NARNIA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7321
Mailing Address - Country:US
Mailing Address - Phone:817-715-5575
Mailing Address - Fax:
Practice Address - Street 1:2638 NARNIA WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7321
Practice Address - Country:US
Practice Address - Phone:813-528-8000
Practice Address - Fax:813-428-6787
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor