Provider Demographics
NPI:1780488312
Name:TIPTON, BENNETT PIERCE (DACHM)
Entity type:Individual
Prefix:
First Name:BENNETT
Middle Name:PIERCE
Last Name:TIPTON
Suffix:
Gender:M
Credentials:DACHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 N 7TH ST APT 2301
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5048
Mailing Address - Country:US
Mailing Address - Phone:214-507-6737
Mailing Address - Fax:
Practice Address - Street 1:760 N 7TH ST APT 2301
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5048
Practice Address - Country:US
Practice Address - Phone:214-507-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist