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General NPI Number Information
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NPI Number | 1700875531
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Entity Type | Individual
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Provider Name | GERALD WANE RUPP D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 314 2ND ST E
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City | HASTINGS
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State | MN
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Zip | 55033-1259
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Country | US
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Telephone | 651-437-9411
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Fax |
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Provider Business Mailing Address
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Address Line | 314 2ND ST E
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City | HASTINGS
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State | MN
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Zip | 55033-1259
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Country | US
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Telephone | 651-437-9411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2847
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License Number State | MN
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