Provider Demographics
NPI:1558586727
Name:LIPIEC, OLAV E (DC)
Entity Type:Individual
Prefix:DR
First Name:OLAV
Middle Name:E
Last Name:LIPIEC
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 1:26044 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-7263
Mailing Address - Country:US
Mailing Address - Phone:660-582-4134
Mailing Address - Fax:
Practice Address - Street 1:26044 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-7263
Practice Address - Country:US
Practice Address - Phone:660-582-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1335164OtherTAX ID #
MO0006403Medicare ID - Type UnspecifiedTRADING PARTNER NUMBER