Provider Demographics
NPI:1831292150
Name:KRIPPENDORF, DONALD J (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:KRIPPENDORF
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 1:4641 PARK STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709
Mailing Address - Country:US
Mailing Address - Phone:727-544-7878
Mailing Address - Fax:727-546-9253
Practice Address - Street 1:4641 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4023
Practice Address - Country:US
Practice Address - Phone:727-544-7878
Practice Address - Fax:727-546-9253
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001769111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89606OtherBLUE CROSS/BLUE SHIELD
FL050460200Medicaid
FL2214123OtherAETNA HMO
FL050460200Medicaid
FL89606ZMedicare ID - Type UnspecifiedMEDICARE