Active NPI
Jerry William Dippe, DC
- Chiropractor
- Sebastopol, CA
National Provider Identifier
1083741144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC10776
- Practice address
- 7765 Bodega Ave
Sebastopol, CA 95472 - Phone
- (707) 823-6406
- Fax
- (707) 823-6408
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC10776 | CA | Primary |
| Chiropractor | 111N00000X | DC001454L | PA |
Addresses
Primary practice location
7765 Bodega Ave
Sebastopol, CA 95472
Mailing address
7765 Bodega Ave
Sebastopol, CA 95472
Phone (707) 823-6406
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ542232 | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC10776 | CA | MD | Chiropractor |
| DC001454L | PA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212969600000",
"number": "1083741144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7765 BODEGA AVE",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "95472",
"telephone_number": "707-823-6406",
"fax_number": "707-823-6408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7765 BODEGA AVE",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "95472",
"telephone_number": "707-823-6406",
"fax_number": "707-823-6408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIPPE",
"first_name": "JERRY",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2008-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC10776",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "PA",
"license": "DC001454L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ542232",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sebastopol, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.