Provider Demographics
NPI:1255646881
Name:KIPP, ADAM DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:KIPP
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 1:112 ENCINITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3642
Mailing Address - Country:US
Mailing Address - Phone:760-632-9736
Mailing Address - Fax:760-632-6948
Practice Address - Street 1:112 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3642
Practice Address - Country:US
Practice Address - Phone:760-632-9736
Practice Address - Fax:760-632-6948
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor