Provider Demographics
NPI:1073131389
Name:DR. PAUL TRIPP D.C. LLC
Entity Type:Organization
Organization Name:DR. PAUL TRIPP D.C. LLC
Other - Org Name:DR PAUL TRIPP D.C. LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER /CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-843-1762
Mailing Address - Street 1:901 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3608
Mailing Address - Country:US
Mailing Address - Phone:770-843-1762
Mailing Address - Fax:
Practice Address - Street 1:901 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3608
Practice Address - Country:US
Practice Address - Phone:770-843-1762
Practice Address - Fax:678-840-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty