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1568479350

NPI Code Detail

MEDICARE: DR. JESSICA DE MARIE LUPO D.C.

MEDICARE: DR. JESSICA DE MARIE LUPO D.C.

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	2301008650	MI
2	225100000X	Physical Therapist	2301008650	MI
3	111NX0100X	Occupational Health Chiropractor	2301008650	MI
4	111NI0013X	Independent Medical Examiner Chiropractor	2301008650	MI
5	111NR0400X	Rehabilitation Chiropractor	2301008650	MI
6	111NP0017X	Pediatric Chiropractor	2301008650	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00378726	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JL008650	OTHER	MI	BLUE CROSS BLUE SHIELD
2	2301008650	OTHER	MI	BCBS MI
4	40734	OTHER	MI	HEALTH PLAN OF MICHIGAN
5	152231	OTHER	MI	GREAT LAKES HEALTH PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568479350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA DE MARIE LUPO D.C.

Provider Business Mailing Address
First Line	:	27850 GRATIOT AVE
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4803
Country	:	US
Telephone Number	:	586-772-5876
Fax Number	:	586-772-1122

Provider Business Practice Location Address
First Line	:	27850 GRATIOT AVE
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4803
Country	:	US
Telephone Number	:	586-772-5876
Fax Number	:	586-772-1122

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	06/08/2011

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Directions to “ DR. JESSICA DE MARIE LUPO D.C.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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