Dereck Desmond Shaw, L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

216398 Issued in OR

Practice address

910 NE D St
Grants Pass, OR 97526-2325

Phone

(541) 476-4611

NPI assigned

Jun 25, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Active Sports and Family Chiropractic LLC

  • Chiropractor
  • Grants Pass, OR
  • NPI 1982174264
  NPD (past)
• Meridian Acupuncture LLC

  • Acupuncturist
  • Myrtle Creek, OR
  • NPI 1336808302
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1124863857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 SMOKEY LN",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975274840",
            "telephone_number": "541-373-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 NE D ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262325",
            "telephone_number": "541-476-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "DERECK",
        "middle_name": "DESMOND",
        "credential": "L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "216398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Sharp
• Erik Sharp, FNP-C
• Jerry L Sharpe Jr., PSS
• Joshua Sharpe
• Lalena Shaver
• Jordan D Shaw, D.C.
• Michael Darran Shea, QMHA
• Dana Sheehan, DNP, APRN-BC
• Mitchell K Sheeler, LD
• Sheer Medical LLC

• All providers in Grants Pass, OR
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.