Provider Demographics
NPI:1871573329
Name:KIPP, ROBERT W JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:KIPP
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2600 POST RD
Mailing Address - Street 2:SUITE L2
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1258
Mailing Address - Country:US
Mailing Address - Phone:203-333-2700
Mailing Address - Fax:203-333-2703
Practice Address - Street 1:2600 POST RD
Practice Address - Street 2:SUITE L2
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1258
Practice Address - Country:US
Practice Address - Phone:203-333-2700
Practice Address - Fax:203-333-2703
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001651111N00000X
NY010688111N00000X
FLCH8501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95381Medicare UPIN