=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104193291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 11/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19470 COASTAL HWY UNIT 3
-----------------------------------------------------
City | REHOBOTH BEACH
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19971-6127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-226-1234
-----------------------------------------------------
Fax | 302-226-1883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19470 COASTAL HWY UNIT 3
-----------------------------------------------------
City | REHOBOTH BEACH
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19971-6127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-226-1234
-----------------------------------------------------
Fax | 302-226-1883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GARY CHARLES TRUPO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 302-226-1234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | F1-0000786
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------