Provider Demographics
NPI:1346472289
Name:MARK CUPPS DC, PC
Entity Type:Organization
Organization Name:MARK CUPPS DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CUPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-742-4332
Mailing Address - Street 1:212 E IVINSON AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3039
Mailing Address - Country:US
Mailing Address - Phone:307-742-4332
Mailing Address - Fax:307-745-1536
Practice Address - Street 1:212 E IVINSON AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3039
Practice Address - Country:US
Practice Address - Phone:307-742-4332
Practice Address - Fax:307-745-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty