Provider Demographics
NPI:1073848263
Name:RUPERT CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:RUPERT CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:RUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-483-4242
Mailing Address - Street 1:1001 MCKEAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2142
Mailing Address - Country:US
Mailing Address - Phone:724-483-4242
Mailing Address - Fax:724-483-4729
Practice Address - Street 1:1001 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2142
Practice Address - Country:US
Practice Address - Phone:724-483-4242
Practice Address - Fax:724-483-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007609-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU79515Medicare UPIN