Provider Demographics
NPI:1487729869
Name:LIPPS, MICHAEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:LIPPS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:HARMONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16422-0366
Mailing Address - Country:US
Mailing Address - Phone:814-382-7782
Mailing Address - Fax:814-382-7782
Practice Address - Street 1:10889 PLUM ST.
Practice Address - Street 2:
Practice Address - City:HARMONSBURG
Practice Address - State:PA
Practice Address - Zip Code:16422-0366
Practice Address - Country:US
Practice Address - Phone:814-382-7782
Practice Address - Fax:814-382-7782
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019424800002Medicaid
PAU92390Medicare UPIN
PA063699Q3HMedicare ID - Type Unspecified