Organization
INTERSTATE CHIROPRACTIC SHAW ROBERT N & E M WAGNER PTRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT SHAW DC (OWNER)
(860) 621-1919
Entity
Organization
Contact information
Practice address
1783 MERIDEN WATERBURY TURNPIKE, MILLDALE, CT 06467-0475
(860) 621-1919
Mailing address
1783 MERIDEN WATERBURY TPKE, MILLDALE, CT 06467-0475
(860) 621-1919
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CT01066
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050001066CT01
BC/BS LEGACY PROVIDER ID
CT
Enumeration date
01/28/2008
Last updated
06/16/2008
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