Provider Demographics
NPI:1497195424
Name:LIPNICK, JEFFREY MARTIN (LMT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:LIPNICK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 PEARL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4668
Mailing Address - Country:US
Mailing Address - Phone:203-312-3597
Mailing Address - Fax:
Practice Address - Street 1:2299 PEARL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4668
Practice Address - Country:US
Practice Address - Phone:203-312-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0008166225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist