Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4487 | KY |
NPI | 1003844267 |
---|---|
Provider Name | John Christopher Sipple |
First Address | Berea, KY 40403-1151 |
Second Address | Berea, KY 40403-1151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 27/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100143650 | (05) | KY |
P100019681 | MEDICARE PTAN (01) | KY |