Healthcare Provider Details

I. General information

NPI: 1679118046
Provider Name (Legal Business Name): SHIPMAN CHIROPRACTIC & WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4557 UTICA RIDGE RD
BETTENDORF IA
52722-1641
US

IV. Provider business mailing address

4557 UTICA RIDGE RD
BETTENDORF IA
52722-1641
US

V. Phone/Fax

Practice location:
  • Phone: 563-359-1985
  • Fax: 563-355-2300
Mailing address:
  • Phone: 563-359-1985
  • Fax: 563-355-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LACY M SKAHILL
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 563-359-1985