Healthcare Provider Details

I. General information

NPI: 1629077417
Provider Name (Legal Business Name): RUPA DARA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 SYLVAN WAY
BREMERTON WA
98310-2813
US

IV. Provider business mailing address

1018 SYLVAN WAY
BREMERTON WA
98310-2813
US

V. Phone/Fax

Practice location:
  • Phone: 360-373-3026
  • Fax: 360-373-5301
Mailing address:
  • Phone: 360-373-3026
  • Fax: 360-373-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3043
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: