Healthcare Provider Details

I. General information

NPI: 1295848380
Provider Name (Legal Business Name): JEFFREY DAVID LIPP DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BOWDEN RD 200
JACKSONVILLE FL
32216-8070
US

IV. Provider business mailing address

6500 BOWDEN RD 200
JACKSONVILLE FL
32216-8070
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-0202
  • Fax: 904-296-0505
Mailing address:
  • Phone: 904-296-0202
  • Fax: 904-296-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH9014
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCH9014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: