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General NPI Number Information
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NPI Number | 1770884520
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Entity Type | Organization
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Legal Business Name | KRUPP CHIROPRACTIC & SPORTS INJURY CENTER
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 40 CLAY ST
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City | TIFFIN
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State | OH
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Zip | 44883-2241
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Country | US
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Telephone | 419-447-1111
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Fax | 419-447-1112
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Provider Business Mailing Address
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Address Line | 40 CLAY ST
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City | TIFFIN
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State | OH
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Zip | 44883-2241
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Country | US
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Telephone | 419-447-1111
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Fax | 419-447-1112
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN/OWNER
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Name | DR. BRETT EDWARD KRUPP
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Credential | D.C.
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Telephone | 419-447-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 4040
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License Number State | OH
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