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1851457139

NPI Code Detail

MEDICARE: DR. JEFFREY JOSEPH LUPO D.C.

MEDICARE: DR. JEFFREY JOSEPH 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	225100000X	Physical Therapist	2301008227	MI
2	111NX0100X	Occupational Health Chiropractor	2301008227	MI
3	111NP0017X	Pediatric Chiropractor	2301008227	MI
4	111N00000X	Chiropractor	2301008227	MI
5	111NR0400X	Rehabilitation Chiropractor	2301008227	MI
6	111NI0013X	Independent Medical Examiner Chiropractor	2301008227	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23692	OTHER	MI	HEALTH PLAN OF MICHIGAN
2	139635	OTHER	MI	GREAT LAKES NUMBER
3	(NPI #)	OTHER	MI	COVENTRY / OMNICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P00011506	OTHER	MI	RAIL ROAD NUMBER
6	JL008227	OTHER	MI	LICENSE NUMBER
7	950G410360	OTHER	MI	BLUE CROSS PROVIDER CODE

General Provider Information

NPI Number	:	1851457139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY JOSEPH 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	:	12/29/2006
Last Update Date	:	06/08/2011

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Directions to “ DR. JEFFREY JOSEPH LUPO D.C.” Practice Location

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