Healthcare Provider Details

I. General information

NPI: 1639433295
Provider Name (Legal Business Name): KUPERUS FAMILY CHIROPRACTIC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LYNDON LN SUITE 102
LOUISVILLE KY
40222-5550
US

IV. Provider business mailing address

105 LYNDON LN SUITE 102
LOUISVILLE KY
40222-5550
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-6715
  • Fax: 502-426-6716
Mailing address:
  • Phone: 502-426-6715
  • Fax: 502-426-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5228
License Number StateKY

VIII. Authorized Official

Name: DR. RACHAEL A KUPERUS
Title or Position: PRESIDENT
Credential: DC
Phone: 502-426-6715