MEDICARE: DR. JUDY A. LIPKA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1029	AL
2	111NN0400X	Neurology Chiropractor	1029	AL
3	111NS0005X	Sports Physician Chiropractor	1029	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-10379	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396827366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY A. LIPKA D.C.

Provider Business Mailing Address
First Line	:	5631 COTTAGE HILL RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-4210
Country	:	US
Telephone Number	:	251-661-3330
Fax Number	:	251-661-3317

Provider Business Practice Location Address
First Line	:	5631 COTTAGE HILL RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-4210
Country	:	US
Telephone Number	:	251-661-3330
Fax Number	:	251-661-3317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/04/2015

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