Robert N Shaw, DC
Individual provider Active NPI Chiropractor · Milldale, CT
NPI 1376587055 · NPPES record last updated Feb 7, 2008
Key facts
- NPI
- 1376587055
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 001066 (CT)
- Practice address
- 1783 Meriden Waterbury Tpke
Milldale, CT 06467-0475 - Phone
- (860) 621-1919
- Fax
- (860) 628-5086
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001066 | CT | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interstate Chiropractic Shaw Robert N & E M Wagner PTRS | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 001066 | CT | Yes |
Addresses
Primary practice location
1783 Meriden Waterbury Tpke
Milldale, CT 06467-0475
Mailing address
1783 Meriden Waterbury Tpke
Milldale, CT 06467-0475
Phone (860) 621-1919
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050001066CT01 | Other | CT | ANTHEM BCBS |
Other providers in Milldale, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.