Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33898 | CA |
N | 111NN0400X | Neurology | 33898 | CA |
N | 111NN1001X | Nutrition | 33898 | CA |
N | 111NP0017X | Pediatric Chiropractor | 33898 | CA |
NPI | 1619405727 |
---|---|
Provider Name | Jessica Ashlee Lips |
First Address | Oakland, CA 94610-2684 |
Second Address | Oakland, CA 94618-1116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2017 |
Last Update Date | 02/06/2017 |