MEDICARE: RUPP PROHEALTH 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	007338	IA

General Provider Information

NPI Number	:	1447556394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUPP PROHEALTH CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	641 PENNSYLVANIA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-2116
Country	:	US
Telephone Number	:	641-682-4556
Fax Number	:	641-682-8473

Provider Business Practice Location Address
First Line	:	641 PENNSYLVANIA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-2116
Country	:	US
Telephone Number	:	641-682-4556
Fax Number	:	641-682-8473

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. RICHARD W RUPP
Credential	:
Telephone Number	:	641-682-4556

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	03/28/2011

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