Provider Demographics
NPI:1255604955
Name:PHIPPS, JASON (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PHIPPS
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 1:59 HAWKS LANDING CIR
Mailing Address - Street 2:APT 218
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8051
Mailing Address - Country:US
Mailing Address - Phone:910-391-0826
Mailing Address - Fax:
Practice Address - Street 1:59 HAWKS LANDING CIR
Practice Address - Street 2:APT 218
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8051
Practice Address - Country:US
Practice Address - Phone:910-391-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4785-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor