Provider Demographics
NPI:1861685489
Name:LIPHAM, JESSICA (ND, DOM)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:LIPHAM
Suffix:
Gender:F
Credentials:ND, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7668 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6884
Mailing Address - Country:US
Mailing Address - Phone:941-525-7219
Mailing Address - Fax:
Practice Address - Street 1:7668 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6884
Practice Address - Country:US
Practice Address - Phone:941-525-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2281171100000X
MENP 293175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath