Provider Demographics
NPI:1295565794
Name:JOLLY, VIPUL (DC)
Entity type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:
Last Name:JOLLY
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 1:951B EDGEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3796
Mailing Address - Country:US
Mailing Address - Phone:650-212-1414
Mailing Address - Fax:
Practice Address - Street 1:951B EDGEWATER BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-3796
Practice Address - Country:US
Practice Address - Phone:650-212-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor