Provider Demographics
NPI:1073715850
Name:LIPPINCOTT, JEFFREY SPRAGUE (LAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SPRAGUE
Last Name:LIPPINCOTT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3147
Mailing Address - Country:US
Mailing Address - Phone:509-607-9952
Mailing Address - Fax:
Practice Address - Street 1:105 W 5TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3178
Practice Address - Country:US
Practice Address - Phone:509-607-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002972171100000X
WAMA00020535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist