Provider Demographics
NPI:1922000389
Name:NIPPLE, VINCENT DECOSTA (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DECOSTA
Last Name:NIPPLE
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 1:805 E HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-3017
Mailing Address - Country:US
Mailing Address - Phone:330-343-5815
Mailing Address - Fax:330-343-5020
Practice Address - Street 1:805 E HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3017
Practice Address - Country:US
Practice Address - Phone:330-343-5815
Practice Address - Fax:330-343-5020
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133877Medicaid
0384571Medicare ID - Type Unspecified
T80387Medicare UPIN