Provider Demographics
NPI:1245989607
Name:TIPTON, ANGELEIA E (DTCM)
Entity type:Individual
Prefix:
First Name:ANGELEIA
Middle Name:E
Last Name:TIPTON
Suffix:
Gender:F
Credentials:DTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 SW CENTURY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1199
Mailing Address - Country:US
Mailing Address - Phone:541-690-5100
Mailing Address - Fax:
Practice Address - Street 1:339 SW CENTURY DR STE 103
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1199
Practice Address - Country:US
Practice Address - Phone:541-690-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC207999171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist