Provider Demographics
NPI:1306813076
Name:RUPERT, MICHAEL SHAWN (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:RUPERT
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 1:1001 MCKEAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2142
Mailing Address - Country:US
Mailing Address - Phone:724-483-4242
Mailing Address - Fax:724-483-4729
Practice Address - Street 1:1001 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2142
Practice Address - Country:US
Practice Address - Phone:724-483-4242
Practice Address - Fax:724-483-4729
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007609L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor