Provider Demographics
NPI:1912124165
Name:PHIPPS, NICOLE LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNNE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:LYNNE
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1288 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3577
Mailing Address - Country:US
Mailing Address - Phone:248-652-2992
Mailing Address - Fax:
Practice Address - Street 1:111 ROCHDALE DR S STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2274
Practice Address - Country:US
Practice Address - Phone:248-652-8686
Practice Address - Fax:248-601-2933
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV04956Medicare UPIN
MIP15580002Medicare ID - Type Unspecified