Provider Demographics
NPI:1053475756
Name:SHIPLEY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SHIPLEY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SHIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-797-2922
Mailing Address - Street 1:2292 W MAGEE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4329
Mailing Address - Country:US
Mailing Address - Phone:520-797-2922
Mailing Address - Fax:520-742-0732
Practice Address - Street 1:2292 W MAGEE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-4301
Practice Address - Country:US
Practice Address - Phone:520-797-2922
Practice Address - Fax:520-742-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1053475756Medicare PIN
AZ1164580189Medicare PIN
AZZ102582Medicare PIN
AZZ65819Medicare PIN
AZZ65817Medicare PIN
AZ1952486896Medicare PIN