Provider Demographics
NPI:1407822620
Name:LIPKIN, MARK Z (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:Z
Last Name:LIPKIN
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 1:2595 TAMPA RD STE P
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3131
Mailing Address - Country:US
Mailing Address - Phone:727-787-4787
Mailing Address - Fax:
Practice Address - Street 1:2595 TAMPA RD STE P
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3131
Practice Address - Country:US
Practice Address - Phone:727-787-4787
Practice Address - Fax:727-785-9919
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000475300Medicaid
FL000475300Medicaid