Provider Demographics
NPI:1184737074
Name:SHIPLEY, LAWRENCE ALLEN II (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:SHIPLEY
Suffix:II
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 1:9 GINGER CREST DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3510
Mailing Address - Country:US
Mailing Address - Phone:618-931-2001
Mailing Address - Fax:618-931-6440
Practice Address - Street 1:2502 PONTOON RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4149
Practice Address - Country:US
Practice Address - Phone:618-931-2001
Practice Address - Fax:618-931-6440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL232750Medicare ID - Type Unspecified
ILT35462Medicare UPIN