Provider Demographics
NPI:1245991512
Name:NOVA CHIROPRACTIC - A SHAW OPTIMAL HEALTH CHIROPRACTIC CORP
Entity type:Organization
Organization Name:NOVA CHIROPRACTIC - A SHAW OPTIMAL HEALTH CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-249-0382
Mailing Address - Street 1:844 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5419
Mailing Address - Country:US
Mailing Address - Phone:408-249-0382
Mailing Address - Fax:
Practice Address - Street 1:844 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5419
Practice Address - Country:US
Practice Address - Phone:408-249-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty