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General NPI Number Information
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NPI Number | 1568503704
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Entity Type | Organization
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Legal Business Name | CUPP CHIROPRACTIC CENTER, INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 4824 N MAIN ST
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City | EMINENCE
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State | KY
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Zip | 40019-1018
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Country | US
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Telephone | 502-845-5482
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Fax | 502-845-5149
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Provider Business Mailing Address
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Address Line | 4824 N MAIN ST PO BOX 133
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City | EMINENCE
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State | KY
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Zip | 40019-1018
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Country | US
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Telephone | 502-845-5482
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Fax | 502-845-5149
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE FREDERICK CUPP
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Credential | D.C.
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Telephone | 502-845-5482
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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 | 4096
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License Number State | KY
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