Provider Demographics
NPI:1568588283
Name:LIPPMAN, MARK EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:LIPPMAN
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 1:125 E MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TUCKERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-2669
Mailing Address - Country:US
Mailing Address - Phone:609-296-4404
Mailing Address - Fax:609-296-2834
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:TUCKERTON
Practice Address - State:NJ
Practice Address - Zip Code:08087-2669
Practice Address - Country:US
Practice Address - Phone:609-296-4404
Practice Address - Fax:609-296-2834
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00440500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035120Medicare UPIN