Provider Demographics
NPI:1073851747
Name:ZUPKE, ANTHONY JOHN
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOHN
Last Name:ZUPKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 W 77TH ST
Mailing Address - Street 2:140
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5008
Mailing Address - Country:US
Mailing Address - Phone:612-886-7763
Mailing Address - Fax:
Practice Address - Street 1:4570 W 77TH ST
Practice Address - Street 2:140
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5008
Practice Address - Country:US
Practice Address - Phone:612-886-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor