Healthcare Provider Details

I. General information

NPI: 1790795334
Provider Name (Legal Business Name): JARROD BLAIRE LIPPY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N CHARLES ST
BALTIMORE MD
21201-5021
US

IV. Provider business mailing address

901 MAIDEN CHOICE LN
BALTIMORE MD
21229-4840
US

V. Phone/Fax

Practice location:
  • Phone: 410-347-3590
  • Fax: 410-347-3592
Mailing address:
  • Phone: 443-983-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number02161S
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: