Provider Demographics
NPI:1346466158
Name:LUPO, DEAN A (DC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:LUPO
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 1:786 KING GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1929
Mailing Address - Country:US
Mailing Address - Phone:732-738-8044
Mailing Address - Fax:
Practice Address - Street 1:786 KING GEORGE RD
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1929
Practice Address - Country:US
Practice Address - Phone:732-738-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC003820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ671227Medicare ID - Type UnspecifiedPROVIDER #