MEDICARE: TIMOTHY J KRUPA 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	1458	OR

General Provider Information

NPI Number	:	1659527240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY J KRUPA DC

Provider Business Mailing Address
First Line	:	PO BOX 953
Second Line	:
City	:	CANNON BEACH
State	:	OR
Zip	:	97110-0953
Country	:	US
Telephone Number	:	503-436-8772
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 N SPRUCE ST.
Second Line	:
City	:	CANNON BEACH
State	:	OR
Zip	:	97110-0953
Country	:	US
Telephone Number	:	503-436-8772
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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