MEDICARE: KRUPP CHIROPRACTIC & SPORTS INJURY CENTER

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	302R00000X	Health Maintenance Organization	4040	OH

General Provider Information

NPI Number	:	1770884520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRUPP CHIROPRACTIC & SPORTS INJURY CENTER

Provider Business Mailing Address
First Line	:	40 CLAY ST
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-2241
Country	:	US
Telephone Number	:	419-447-1111
Fax Number	:	419-447-1112

Provider Business Practice Location Address
First Line	:	40 CLAY ST
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-2241
Country	:	US
Telephone Number	:	419-447-1111
Fax Number	:	419-447-1112

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN/OWNER
Name	:	DR. BRETT EDWARD KRUPP
Credential	:	D.C.
Telephone Number	:	419-447-1111

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	12/05/2014

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