Provider Demographics
NPI:1518950963
Name:LIPKIN, GARY R (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
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 1:300 E LOOP 281
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7912
Mailing Address - Country:US
Mailing Address - Phone:903-234-2225
Mailing Address - Fax:
Practice Address - Street 1:300 E LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7912
Practice Address - Country:US
Practice Address - Phone:903-234-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC3056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T14427Medicare UPIN
TX601500Medicare ID - Type Unspecified