MEDICARE: KUPER SPINE AND JOINT CENTER, 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	08002599A	IN

General Provider Information

NPI Number	:	1740690981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUPER SPINE AND JOINT CENTER, LLC

Provider Business Mailing Address
First Line	:	4735 STATESMEN DR
Second Line	:	SUITE E
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5646
Country	:	US
Telephone Number	:	317-712-3961
Fax Number	:	317-712-3963

Provider Business Practice Location Address
First Line	:	4735 STATESMEN DR
Second Line	:	SUITE E
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-5646
Country	:	US
Telephone Number	:	317-712-3961
Fax Number	:	317-712-3963

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. SCOTT KUPER
Credential	:	D.C.
Telephone Number	:	317-712-3961

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	04/28/2014

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