Individual provider Active NPI

Robert W Kipp Jr., D.C.

  • Chiropractor
  • Southport, CT
National Provider Identifier
1871573329
Registry record updated Mar 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
001651 Issued in CT
Practice address
2600 Post Rd
Suite L2
Southport, CT 06890-1258
Phone
(203) 333-2700
Fax
(203) 333-2703
NPI assigned
Jan 20, 2006
Last updated
Mar 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 001651 CT Primary
Chiropractor 111N00000X 010688 NY
Chiropractor 111N00000X CH8501 FL

Addresses

Primary practice location

2600 Post Rd
Suite L2
Southport, CT 06890-1258

Mailing address

2600 Post Rd
Suite L2
Southport, CT 06890-1258
Phone (203) 333-2700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070409000216 CT Practitioner - Chiropractic 8224040258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2600 Post Rd
Suite L2
Southport, CT 06890-1258
Phone (203) 333-2700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH8501FLMDChiropractor
001651CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pro-Health Chiropractic, P.C. Chiropractor CurrentSince Mar 22, 2007 Accepting new patients
East Greenbush Chiropractic Chiropractor Past Accepting new patients
East Greenbush Chiropractic PLLC Chiropractor Past Accepting new patients
East Greenbush Chiropractic PLLC Chiropractor PastSince Jun 23, 2018 Accepting new patients

Locations

2600 Post Rd
Ste L2
Southport, CT 06890
Phone (203) 254-9432

Organizations & group practices 4

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": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331510400000",
    "number": "1871573329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 POST RD",
            "address_2": "SUITE L2",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901258",
            "telephone_number": "203-333-2700",
            "fax_number": "203-333-2703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 POST RD",
            "address_2": "SUITE L2",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901258",
            "telephone_number": "203-333-2700",
            "fax_number": "203-333-2703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIPP",
        "first_name": "ROBERT",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2012-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "001651",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "010688",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.