Provider Demographics
NPI:1790866499
Name:RIPP, SEAN T
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:T
Last Name:RIPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9464 GREEN VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4550
Mailing Address - Country:US
Mailing Address - Phone:702-736-8030
Mailing Address - Fax:702-221-4853
Practice Address - Street 1:8665 W FLAMINGO RD
Practice Address - Street 2:STE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8621
Practice Address - Country:US
Practice Address - Phone:702-384-0000
Practice Address - Fax:702-221-4853
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000026-205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor