Provider Demographics
NPI:1164965083
Name:RUPP, STEVEN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:RUPP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8050
Mailing Address - Country:US
Mailing Address - Phone:907-790-3371
Mailing Address - Fax:907-790-2102
Practice Address - Street 1:2243 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-790-3371
Practice Address - Fax:907-790-2102
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor