Provider Demographics
NPI:1366171654
Name:SHAW FAMILY PRACTICE PC
Entity type:Organization
Organization Name:SHAW FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CHIEF CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JO NELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:970-658-1281
Mailing Address - Street 1:148 W OAK ST STE C
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2893
Mailing Address - Country:US
Mailing Address - Phone:970-658-1281
Mailing Address - Fax:970-844-8884
Practice Address - Street 1:148 W OAK ST STE C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2893
Practice Address - Country:US
Practice Address - Phone:970-658-1281
Practice Address - Fax:970-844-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty