Healthcare Provider Details

I. General information

NPI: 1528064342
Provider Name (Legal Business Name): SARA JEAN CUPERUS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA JEAN KLEIN D.C.

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 TROOP DRIVE SUITE 201
SARTELL MN
56377-4637
US

IV. Provider business mailing address

2380 TROOP DRIVE SUITE 201
SARTELL MN
56377-4637
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-0961
  • Fax: 320-258-4001
Mailing address:
  • Phone: 320-255-0961
  • Fax: 320-258-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4331
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: