Healthcare Provider Details

I. General information

NPI: 1932330487
Provider Name (Legal Business Name): DUSTIN ALLEN CUPP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E ECONOMY RD
MORRISTOWN TN
37814-3327
US

IV. Provider business mailing address

350 E ECONOMY RD
MORRISTOWN TN
37814-3327
US

V. Phone/Fax

Practice location:
  • Phone: 423-748-9920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2358
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: