Provider Demographics
NPI:1225360357
Name:KRUPP, STEFANIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:
Last Name:KRUPP
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 1:1867 SE ANSPACH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2619
Mailing Address - Country:US
Mailing Address - Phone:610-416-4602
Mailing Address - Fax:
Practice Address - Street 1:1107 7TH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2407
Practice Address - Country:US
Practice Address - Phone:503-656-1415
Practice Address - Fax:503-722-3938
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2024-03-11
Deactivation Date:2016-02-08
Deactivation Code:
Reactivation Date:2023-11-22
Provider Licenses
StateLicense IDTaxonomies
OR5600111N00000X
TX12188111N00000X
PADC010267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor