Healthcare Provider Details

I. General information

NPI: 1518919471
Provider Name (Legal Business Name): JAMES RIPPA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2396 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

IV. Provider business mailing address

2396 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

V. Phone/Fax

Practice location:
  • Phone: 904-781-2300
  • Fax: 904-781-3502
Mailing address:
  • Phone: 904-781-2300
  • Fax: 904-781-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3031
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: