Healthcare Provider Details

I. General information

NPI: 1750428058
Provider Name (Legal Business Name): LUPO CHIROPRACTIC LIFE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27850 GRATIOT AVE
ROSEVILLE MI
48066-4803
US

IV. Provider business mailing address

27850 GRATIOT AVE
ROSEVILLE MI
48066-4803
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-5876
  • Fax: 586-772-1122
Mailing address:
  • Phone: 586-772-5876
  • Fax: 586-772-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. JOSEPH LUPO
Title or Position: OWNER
Credential: D.C.
Phone: 586-772-5876