Provider Demographics
NPI:1619904265
Name:SIPPLE, JOHN DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:SIPPLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:SIPPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:502 RICHMOND RD N, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1151
Mailing Address - Country:US
Mailing Address - Phone:859-986-2225
Mailing Address - Fax:859-986-7477
Practice Address - Street 1:502 RICHMOND RD N, SUITE 2
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1151
Practice Address - Country:US
Practice Address - Phone:859-986-2225
Practice Address - Fax:859-986-7477
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU85174Medicare UPIN
KY0672602Medicare ID - Type UnspecifiedMEDICARE