MEDICARE: MICHAEL CHARLES LIPKIN DC

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	DC 11964	CA

General Provider Information

NPI Number	:	1902989585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CHARLES LIPKIN DC

Provider Business Mailing Address
First Line	:	2877 LAKE TAHOE BLVD
Second Line	:	SUITE B
City	:	SO LAKE TAHOE
State	:	CA
Zip	:	96150
Country	:	US
Telephone Number	:	530-544-8495
Fax Number	:	530-544-5306

Provider Business Practice Location Address
First Line	:	2877 LAKE TAHOE BLVD
Second Line	:	SUITE B
City	:	SO LAKE TAHOE
State	:	CA
Zip	:	96150
Country	:	US
Telephone Number	:	530-544-8495
Fax Number	:	530-544-5306

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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