Provider Demographics
NPI:1104896661
Name:SHIPP, JOHN RUSSELL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSELL
Last Name:SHIPP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CREEK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1372
Mailing Address - Country:US
Mailing Address - Phone:501-515-4550
Mailing Address - Fax:
Practice Address - Street 1:202 S CROSS ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1910
Practice Address - Country:US
Practice Address - Phone:501-244-2400
Practice Address - Fax:501-244-2401
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
233350AMedicare ID - Type Unspecified
U97022Medicare UPIN