Provider Demographics
NPI:1538204425
Name:SHIPMAN CHIROPRACTIC PC
Entity type:Organization
Organization Name:SHIPMAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SKAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
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:52807-1614
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:52807-1623
Practice Address - Country:US
Practice Address - Phone:563-359-1985
Practice Address - Fax:563-355-2300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIPMAN CHIROPRACTIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
IA208D00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104778Medicaid
IA0498170Medicaid
IA19257OtherBLUE CROSS BLUE SHIELD
IA0498170Medicaid
IAU45391Medicare UPIN