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General NPI Number Information
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NPI Number | 1124823885
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Entity Type | Organization
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Legal Business Name | LIPS CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1540 HWY 116 S
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City | SEBASTOPOL
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State | CA
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Zip | 95472-4835
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Country | US
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Telephone | 707-200-3194
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Fax |
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Provider Business Mailing Address
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Address Line | 2336 WESTVIEW WAY
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City | SANTA ROSA
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State | CA
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Zip | 95403-2384
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA LIPS WANGERIN
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Credential | DC
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Telephone | 314-609-4694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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