MEDICARE: CAPE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	F1-0000786	DE

General Provider Information

NPI Number	:	1104193291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	19470 COASTAL HWY UNIT 3
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-6127
Country	:	US
Telephone Number	:	302-226-1234
Fax Number	:	302-226-1883

Provider Business Practice Location Address
First Line	:	19470 COASTAL HWY UNIT 3
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-6127
Country	:	US
Telephone Number	:	302-226-1234
Fax Number	:	302-226-1883

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY CHARLES TRUPO
Credential	:	D.C.
Telephone Number	:	302-226-1234

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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