Provider Demographics
NPI:1568446896
Name:LIPSON, LANNY BERT (DC)
Entity Type:Individual
Prefix:
First Name:LANNY
Middle Name:BERT
Last Name:LIPSON
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 1:31850 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-1983
Mailing Address - Country:US
Mailing Address - Phone:586-293-4440
Mailing Address - Fax:586-293-0840
Practice Address - Street 1:31850 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-1983
Practice Address - Country:US
Practice Address - Phone:586-293-4440
Practice Address - Fax:586-293-0840
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALL004787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor