Provider Demographics
NPI:1154386894
Name:TIPTON, JAMES R (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:TIPTON
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 1:2615 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3807
Mailing Address - Country:US
Mailing Address - Phone:812-265-5369
Mailing Address - Fax:812-273-5517
Practice Address - Street 1:2615 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3807
Practice Address - Country:US
Practice Address - Phone:812-265-5369
Practice Address - Fax:812-273-5517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000590A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085361OtherANTHEM
IN4350422OtherAETNA
IN4350422OtherAETNA