Healthcare Provider Details

I. General information

NPI: 1417019712
Provider Name (Legal Business Name): CUPP CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SEVERN AVE STE B
METAIRIE LA
70002-3482
US

IV. Provider business mailing address

3535 SEVERN AVE STE B
METAIRIE LA
70002-3482
US

V. Phone/Fax

Practice location:
  • Phone: 504-888-1185
  • Fax: 985-626-6995
Mailing address:
  • Phone: 504-888-1185
  • Fax: 985-626-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. REEANN CUPP
Title or Position: PRESIDENT
Credential: DC
Phone: 504-888-1185