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Individual

DR. CHALYSE H. SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DC

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
111NN1001X
Nutrition Chiropractor
Primary
S01715PT
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
390546
MAMSI
MD
01
M253CH
BLUECROSSBLUESHIELD
MD
01
R7290001
FEDERAL BLUECROSSSHIELD
MD
Enumeration date
01/06/2007
Last updated
05/12/2010
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