Provider Demographics
NPI:1568503704
Name:CUPP CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:CUPP CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:CUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-845-5482
Mailing Address - Street 1:4824 N MAIN ST
Mailing Address - Street 2:PO BOX 133
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019-1018
Mailing Address - Country:US
Mailing Address - Phone:502-845-5482
Mailing Address - Fax:502-845-5149
Practice Address - Street 1:4824 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019-1018
Practice Address - Country:US
Practice Address - Phone:502-845-5482
Practice Address - Fax:502-845-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100149320Medicaid
KYU05625Medicare UPIN
KY7100149320Medicaid