Healthcare Provider Details

I. General information

NPI: 1699754838
Provider Name (Legal Business Name): JEFFREY DAVID KUPPERSMITH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N GILBERT RD SUITE 309
GILBERT AZ
85234-4502
US

IV. Provider business mailing address

610 N GILBERT RD SUITE 309
GILBERT AZ
85234-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-1111
  • Fax: 480-926-2958
Mailing address:
  • Phone: 480-926-1111
  • Fax: 480-926-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7280
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: