Provider Demographics
NPI:1205926904
Name:LIPSIE, GREG (DC)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:LIPSIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:LIPSIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:9138 BONITA BEACH RD SE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4291
Mailing Address - Country:US
Mailing Address - Phone:239-947-5600
Mailing Address - Fax:239-947-5865
Practice Address - Street 1:9138 BONITA BEACH RD SE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4291
Practice Address - Country:US
Practice Address - Phone:239-947-5600
Practice Address - Fax:239-947-5865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU93051Medicare UPIN
FL76933Medicare ID - Type Unspecified