Provider Demographics
NPI:1932159365
Name:LIPSITZ, EDWIN L (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:L
Last Name:LIPSITZ
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 1:12106 OLD LINE CTR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2553
Mailing Address - Country:US
Mailing Address - Phone:301-645-8898
Mailing Address - Fax:301-870-4940
Practice Address - Street 1:12106 OLD LINE CTR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2553
Practice Address - Country:US
Practice Address - Phone:301-645-8898
Practice Address - Fax:301-870-4940
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005010L111N00000X
MDS03454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000075206Medicare ID - Type Unspecified
PAU33998Medicare UPIN