Provider Demographics
NPI:1710044938
Name:SHIPMAN, RANDALL EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:EUGENE
Last Name:SHIPMAN
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 1:621 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1614
Mailing Address - Country:US
Mailing Address - Phone:563-359-1985
Mailing Address - Fax:563-355-2300
Practice Address - Street 1:621 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1614
Practice Address - Country:US
Practice Address - Phone:563-359-1985
Practice Address - Fax:563-355-2300
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104778Medicaid
IAI9004Medicare PIN
IA1104778Medicaid