Provider Demographics
NPI:1104261189
Name:D'IPPOLITO CHIROPRACTIC, MASSAGE & BEAUTIFUL IMAGE, PA
Entity type:Organization
Organization Name:D'IPPOLITO CHIROPRACTIC, MASSAGE & BEAUTIFUL IMAGE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-274-9799
Mailing Address - Street 1:1089 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1801
Mailing Address - Country:US
Mailing Address - Phone:828-274-9799
Mailing Address - Fax:828-274-7737
Practice Address - Street 1:1089 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1801
Practice Address - Country:US
Practice Address - Phone:828-274-9799
Practice Address - Fax:828-274-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2941111N00000X
NC8388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085FXMedicaid
NC2455576Medicare UPIN
NCU93100Medicare PIN