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1821154113

NPI Code Detail

MEDICARE: DR. JOSEPH LUPO D.C.

MEDICARE: DR. JOSEPH LUPO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2301002932	MI
2	111N00000X	Chiropractor	2301002932	MI
3	111NX0100X	Occupational Health Chiropractor	2301002932	MI
4	111NP0017X	Pediatric Chiropractor	2301002932	MI
5	111NR0400X	Rehabilitation Chiropractor	2301002932	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	791350714	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2301002932	OTHER	MI	LICENSE NUMBER
3	950Q262880	OTHER	MI	BLUE CARE NETWORK GROUP #
4	152233	OTHER	MI	GREAT LAKES NUMBER
5	40571	OTHER	MI	HEALTH PLAN OF MICHIGAN
6	950Q26288	OTHER	MI	BLUE CROSS PROVIDER CODE
7	JL002932	OTHER	MI	LICENSE NUMBER
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821154113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH LUPO D.C.

Provider Business Mailing Address
First Line	:	27850 GRATIOT AVE
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4803
Country	:	US
Telephone Number	:	586-772-5876
Fax Number	:	586-772-1122

Provider Business Practice Location Address
First Line	:	27850 GRATIOT AVE
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4803
Country	:	US
Telephone Number	:	586-772-5876
Fax Number	:	586-772-1122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/09/2012

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Directions to “ DR. JOSEPH LUPO D.C.” Practice Location

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