MEDICARE: BECKY ROSE RUPERT ND, CNC, CCH

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	175F00000X	Naturopath	001120141	NC
2	175L00000X	Homeopath

General Provider Information

NPI Number	:	1316156581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY ROSE RUPERT ND, CNC, CCH

Provider Business Mailing Address
First Line	:	12931 N. ELYRIA RD.
Second Line	:	PO BOX 535
City	:	WEST SALEM
State	:	OH
Zip	:	44287-9796
Country	:	US
Telephone Number	:	419-853-3805
Fax Number	:	419-853-4741

Provider Business Practice Location Address
First Line	:	12931 N. ELYRIA RD.
Second Line	:
City	:	WEST SALEM
State	:	OH
Zip	:	44287-9796
Country	:	US
Telephone Number	:	419-853-3805
Fax Number	:	419-853-4741

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/18/2013

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