MEDICARE: MR. ERIC LUPER DC

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	X009456-1	NY

General Provider Information

NPI Number	:	1205857059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC LUPER DC

Provider Business Mailing Address
First Line	:	319 BROADWAY
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204
Country	:	US
Telephone Number	:	518-472-9130
Fax Number	:	518-472-9351

Provider Business Practice Location Address
First Line	:	319 BROADWAY
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204
Country	:	US
Telephone Number	:	518-472-9130
Fax Number	:	518-472-9351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/11/2021

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Directions to “ MR. ERIC LUPER DC” Practice Location

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