Provider Demographics
NPI:1497884902
Name:RUPERT, PATRICIA L (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:RUPERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:RUPERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5537 N MILITARY TRL APT 1905
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3497
Mailing Address - Country:US
Mailing Address - Phone:650-219-8851
Mailing Address - Fax:
Practice Address - Street 1:5537 N MILITARY TRL APT 1905
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3497
Practice Address - Country:US
Practice Address - Phone:650-219-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6895171100000X
CADC29527111N00000X
FLAP3766171100000X
FL11955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist