Provider Demographics
NPI:1417019712
Name:CUPP CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CUPP CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-888-1185
Mailing Address - Street 1:3535 SEVERN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3482
Mailing Address - Country:US
Mailing Address - Phone:504-888-1185
Mailing Address - Fax:985-626-6995
Practice Address - Street 1:3535 SEVERN AVE
Practice Address - Street 2:STE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3482
Practice Address - Country:US
Practice Address - Phone:504-888-1185
Practice Address - Fax:985-626-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2509AOtherBLUE CROSS