Provider Demographics
NPI:1073944609
Name:KUPERMAN, JOEL MORRIS (LAC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MORRIS
Last Name:KUPERMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:M
Other - Last Name:KUPERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DA
Mailing Address - Street 1:1324 S GRAND AVE W
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3465
Mailing Address - Country:US
Mailing Address - Phone:847-777-9200
Mailing Address - Fax:
Practice Address - Street 1:1324 S GRAND AVE W
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3465
Practice Address - Country:US
Practice Address - Phone:847-777-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001162133NN1002X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education