Provider Demographics
NPI:1013126846
Name:SIPPLE CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:SIPPLE CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:SIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-734-6555
Mailing Address - Street 1:3090 ANGEL DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9533
Mailing Address - Country:US
Mailing Address - Phone:513-734-3759
Mailing Address - Fax:
Practice Address - Street 1:3090 ANGEL DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9533
Practice Address - Country:US
Practice Address - Phone:513-734-3759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-1340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9306451Medicare ID - Type Unspecified