Organization
CHALYSE H. SHAW, DC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHALYSE H SHAW DC (PRESIDENT)
(410) 357-4889
Entity
Organization
Contact information
Practice address
17112 YORK RD, PARKTON, MD 21120-9717
(410) 357-4889
(410) 357-4435
Mailing address
PO BOX 560, HEREFORD, MD 21111-0560
(410) 357-4889
(410) 357-4435
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
S01715PT
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M253CH
BLUE CROSS/BLUE SHIELD
MD
01
—
R7290001
BLUECROSS/BLUECHOICE
MD
Enumeration date
05/12/2010
Last updated
05/12/2010
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