Provider Demographics
NPI:1407252398
Name:KIPNIS, CHLOE MARIE (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:MARIE
Last Name:KIPNIS
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S ROSSMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3739
Mailing Address - Country:US
Mailing Address - Phone:323-964-8468
Mailing Address - Fax:
Practice Address - Street 1:250 S ROSSMORE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3739
Practice Address - Country:US
Practice Address - Phone:323-964-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer