Provider Demographics
NPI:1710195318
Name:LIPPE, ALBERT MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MICHAEL
Last Name:LIPPE
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 1:2108 S LAMAR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4993
Mailing Address - Country:US
Mailing Address - Phone:512-443-2972
Mailing Address - Fax:512-443-3398
Practice Address - Street 1:2108 S LAMAR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4993
Practice Address - Country:US
Practice Address - Phone:512-443-2972
Practice Address - Fax:512-443-3398
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC2987OtherCHIROPRACTIC LICENSE #
TX601287Medicare ID - Type Unspecified
TXDC2987OtherCHIROPRACTIC LICENSE #