Provider Demographics
NPI:1033207048
Name:KRUPA, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KRUPA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2105
Mailing Address - Country:US
Mailing Address - Phone:508-429-7293
Mailing Address - Fax:508-429-7335
Practice Address - Street 1:25 CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2105
Practice Address - Country:US
Practice Address - Phone:508-429-7293
Practice Address - Fax:508-429-7335
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00539111N00000X
MA3050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor