Provider Demographics
NPI:1104193291
Name:CAPE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CAPE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TRUPO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-226-1234
Mailing Address - Street 1:19470 COASTAL HWY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-6127
Mailing Address - Country:US
Mailing Address - Phone:302-226-1234
Mailing Address - Fax:302-226-1883
Practice Address - Street 1:19470 COASTAL HWY UNIT 3
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6127
Practice Address - Country:US
Practice Address - Phone:302-226-1234
Practice Address - Fax:302-226-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty