Provider Demographics
NPI:1093011843
Name:RUPP, MALLORY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:MARIE
Last Name:RUPP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14609 AMES PLZ
Mailing Address - Street 2:APT. 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1505
Mailing Address - Country:US
Mailing Address - Phone:913-626-0342
Mailing Address - Fax:
Practice Address - Street 1:14609 AMES PLZ
Practice Address - Street 2:APT. 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1505
Practice Address - Country:US
Practice Address - Phone:913-626-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor