Healthcare Provider Details

I. General information

NPI: 1922244268
Provider Name (Legal Business Name): SCOTT MICHAEL KUPER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W 21ST ST SUITE 100
NORFOLK VA
23517-1500
US

IV. Provider business mailing address

2004 SANDBRIDGE RD STE 103
VIRGINIA BEACH VA
23456-4084
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-1222
  • Fax: 757-622-4222
Mailing address:
  • Phone: 412-606-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556671
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: