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NPI Code Detail

MEDICARE: MCKENZIE JERRIT CHUPPE PT, DPT, ATC

MEDICARE: MCKENZIE JERRIT CHUPPE PT, DPT, ATC
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
12255A2300XAthletic TrainerND
2225100000XPhysical Therapist2455ND

General Provider Information

NPI Number : 1548735319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENZIE JERRIT CHUPPE PT, DPT, ATC
Provider Business Mailing Address
First Line : 516 SHALE DR
Second Line :
City : BISMARCK
State : ND
Zip : 58503-6586
Country : US
Telephone Number : 701-595-1555
Fax Number :
Provider Business Practice Location Address
First Line : 3921 LOCKPORT ST
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5541
Country : US
Telephone Number : 701-751-3128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2018
Last Update Date : 03/02/2026

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