Individual provider Active NPI

Jessica Lips Wangerin, DC

  • Chiropractor
  • Sebastopol, CA
National Provider Identifier
1619405727
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
33898 Issued in CA
Practice address
1540 Hwy 116 S
Sebastopol, CA 95472-4835
Phone
(707) 200-3194
NPI assigned
Jun 2, 2017
Last updated
Feb 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 33898 CA Primary
Neurology Chiropractor 111NN0400X 33898 CA
Nutrition Chiropractor 111NN1001X 33898 CA
Pediatric Chiropractor 111NP0017X 33898 CA

Addresses

Primary practice location

1540 Hwy 116 S
Sebastopol, CA 95472-4835

Mailing address

2336 Westview Way
Santa Rosa, CA 95403-2384
Phone (314) 609-4694

Other practice location 1

5545 Claremont Ave
Oakland, CA 94618-1116
Phone (510) 379-9322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250404002555 CA Practitioner - Chiropractic 1153845714 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33898CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lips Chiropractic Inc CurrentSince Feb 1, 2025 Accepting new patients

Locations

1540 Hwy 116 S
Sebastopol, CA 95472
Phone (707) 200-3194

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1619405727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 WESTVIEW WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032384",
            "telephone_number": "314-609-4694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 HWY 116 S",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724835",
            "telephone_number": "707-200-3194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5545 Claremont Ave",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946181116",
            "country_code": "US",
            "telephone_number": "510-379-9322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANGERIN",
        "first_name": "JESSICA",
        "middle_name": "LIPS",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-02",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "33898",
            "primary": true
        },
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "CA",
            "license": "33898",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "CA",
            "license": "33898",
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "CA",
            "license": "33898",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.