MEDICARE: KIMBERLY SHIPMAN L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	9433	CA

General Provider Information

NPI Number	:	1083734222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SHIPMAN L.AC.

Provider Business Mailing Address
First Line	:	53060 AVENIDA DIAZ
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-3429
Country	:	US
Telephone Number	:	760-668-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	73140 HIGHWAY 111 STE 8
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3927
Country	:	US
Telephone Number	:	760-668-3174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	09/01/2011

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Directions to “ KIMBERLY SHIPMAN L.AC.” Practice Location

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