Provider Demographics
NPI:1588773659
Name:SHAW, RODNEY E (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:E
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 1:320 N ROCK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3972
Mailing Address - Country:US
Mailing Address - Phone:316-789-8100
Mailing Address - Fax:316-789-9400
Practice Address - Street 1:320 N ROCK RD STE 300
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3972
Practice Address - Country:US
Practice Address - Phone:316-789-8100
Practice Address - Fax:316-789-9400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060467Medicare ID - Type Unspecified