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General NPI Number Information
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NPI Number | 1972295806
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Entity Type | Individual
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Provider Name | JASEN E. DIPPEL LMT
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 807 W CORBETT AVE STE 8
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City | SWANSBORO
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State | NC
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Zip | 28584-9039
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Country | US
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Telephone | 910-325-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 213 HOLLY ST # 234
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City | HOLLY RIDGE
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State | NC
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Zip | 28445-7879
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 19336
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License Number State | NC
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