1184737074 NPI number — LAWRENCE ALLEN SHIPLEY II D.C.

Table of content: LAWRENCE ALLEN SHIPLEY II D.C. (NPI 1184737074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184737074 NPI number — LAWRENCE ALLEN SHIPLEY II D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPLEY
Provider First Name:
LAWRENCE
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184737074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 GINGER CREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN CARBON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62034-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-931-2001
Provider Business Mailing Address Fax Number:
618-931-6440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2502 PONTOON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE CITY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62040-4149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-931-2001
Provider Business Practice Location Address Fax Number:
618-931-6440
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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