Provider Demographics
NPI:1326366097
Name:RUPP, RICHARD W (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
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 1:641 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2116
Mailing Address - Country:US
Mailing Address - Phone:641-682-4556
Mailing Address - Fax:641-682-8473
Practice Address - Street 1:641 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2116
Practice Address - Country:US
Practice Address - Phone:641-682-4556
Practice Address - Fax:641-682-8473
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor