Provider Demographics
NPI:1679118046
Name:SHIPMAN CHIROPRACTIC & WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:SHIPMAN CHIROPRACTIC & WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-359-1985
Mailing Address - Street 1:4557 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1641
Mailing Address - Country:US
Mailing Address - Phone:563-359-1985
Mailing Address - Fax:563-355-2300
Practice Address - Street 1:4557 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1641
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 & WELLNESS CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19257OtherBLUE CROSS BLUE SHEILD
IA0498170Medicaid
IAI9004OtherMEDICARE PIN
IA1104778Medicaid
IAU45391OtherMEDICARE UPIN