Individual
TIMOTHY J SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
522 HEWETT ST, NEILLSVILLE, WI 54456-1926
(715) 743-3600
Mailing address
601 S 32ND AVE, WAUSAU, WI 54401-3958
(715) 848-2526
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2231-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38798300
—
WI
Enumeration date
09/16/2006
Last updated
10/26/2009
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