Provider Demographics
NPI:1346355906
Name:PHIPPS, JIM DOYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:DOYLE
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37140 STATE HIGHWAY 299 E
Mailing Address - Street 2:A
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4129
Mailing Address - Country:US
Mailing Address - Phone:530-335-3502
Mailing Address - Fax:530-335-3503
Practice Address - Street 1:37140 STATE HIGHWAY 299 E
Practice Address - Street 2:A
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4129
Practice Address - Country:US
Practice Address - Phone:530-335-3502
Practice Address - Fax:530-335-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC112370Medicare UPIN