Provider Demographics
NPI:1104533827
Name:VIPPERMAN, CALEB
Entity type:Individual
Prefix:MR
First Name:CALEB
Middle Name:
Last Name:VIPPERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 CRAIGS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-7361
Mailing Address - Country:US
Mailing Address - Phone:540-239-3922
Mailing Address - Fax:
Practice Address - Street 1:1503 CRAIGS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-7361
Practice Address - Country:US
Practice Address - Phone:540-239-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver