Provider Demographics
NPI:1255692380
Name:WHIPPLE, CHARLEEN LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:LYNN
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E OLD SETTLERS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2211
Mailing Address - Country:US
Mailing Address - Phone:512-763-0616
Mailing Address - Fax:
Practice Address - Street 1:111 E OLD SETTLERS BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2211
Practice Address - Country:US
Practice Address - Phone:512-763-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist