Provider Demographics
NPI:1447215215
Name:BAJAJ, KIPP R (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KIPP
Middle Name:R
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 21ST ST
Mailing Address - Street 2:# 2
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2471
Mailing Address - Country:US
Mailing Address - Phone:360-699-0575
Mailing Address - Fax:
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:STE 1102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-882-7373
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1052175F00000X
WANT00001285175F00000X
WAAC00002577171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered171100000XOther Service ProvidersAcupuncturist