Provider Demographics
NPI:1598769143
Name:SHIPPEY, MARVIN W (DC)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:W
Last Name:SHIPPEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18091 UPPER BAY RD
Mailing Address - Street 2:STE 27
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3528
Mailing Address - Country:US
Mailing Address - Phone:281-333-1894
Mailing Address - Fax:281-333-1894
Practice Address - Street 1:18091 UPPER BAY RD
Practice Address - Street 2:STE 27
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3528
Practice Address - Country:US
Practice Address - Phone:281-333-1894
Practice Address - Fax:281-333-1894
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608117OtherBLUE CROSS BLUE SHIELD
TX611507Medicare ID - Type Unspecified
TXV03885Medicare UPIN