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General NPI Number Information
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NPI Number | 1013126846
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Entity Type | Organization
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Legal Business Name | SIPPLE CLINIC OF CHIROPRACTIC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 3090 ANGEL DR
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City | BETHEL
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State | OH
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Zip | 45106-9533
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Country | US
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Telephone | 513-734-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 3090 ANGEL DR
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City | BETHEL
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State | OH
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Zip | 45106-9533
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Country | US
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Telephone | 513-734-3759
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY O. SIPPLE
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Credential | D.C.
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Telephone | 513-734-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-1340
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License Number State | OH
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