Healthcare Provider Details

I. General information

NPI: 1659661213
Provider Name (Legal Business Name): NORTH SUBURBAN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9464 FEDERAL BLVD
WESTMINSTER CO
80260-5826
US

IV. Provider business mailing address

9464 FEDERAL BLVD
WESTMINSTER CO
80260-5826
US

V. Phone/Fax

Practice location:
  • Phone: 303-426-8916
  • Fax: 303-430-1158
Mailing address:
  • Phone: 303-426-8916
  • Fax: 303-430-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1065
License Number StateCO

VIII. Authorized Official

Name: DONALD MARTIN KUPPE JR.
Title or Position: OWNER
Credential: DC
Phone: 303-426-8916