Provider Demographics
NPI:1710438445
Name:SHIPMAN CHIROPRACTIC
Entity Type:Organization
Organization Name:SHIPMAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-359-1985
Mailing Address - Street 1:621 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1623
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty