Provider Demographics
NPI:1053416578
Name:SHAW, ROBERT D (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
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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Other - Credentials:
Mailing Address - Street 1:1003 E INTERSTATE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0500
Mailing Address - Country:US
Mailing Address - Phone:701-221-2788
Mailing Address - Fax:701-221-2789
Practice Address - Street 1:1003 E INTERSTATE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0500
Practice Address - Country:US
Practice Address - Phone:701-221-2788
Practice Address - Fax:701-221-2789
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDSHA23522OtherBLUECROSS BLUESHIELD
ND711237Medicare UPIN
ND23522Medicare ID - Type Unspecified