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General NPI Number Information
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NPI Number | 1346472289
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Entity Type | Organization
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Legal Business Name | MARK CUPPS DC, PC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 212 E IVINSON AVE
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City | LARAMIE
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State | WY
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Zip | 82070-3039
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Country | US
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Telephone | 307-742-4332
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Fax | 307-745-1536
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Provider Business Mailing Address
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Address Line | 212 E IVINSON AVE
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City | LARAMIE
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State | WY
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Zip | 82070-3039
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Country | US
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Telephone | 307-742-4332
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Fax | 307-745-1536
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | DR. CHARLES MARK CUPPS
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Credential | D.C.
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Telephone | 307-742-4332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 514
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License Number State | WY
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