Provider Demographics
NPI:1578728432
Name:LUPKES FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LUPKES FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-258-4440
Mailing Address - Street 1:3333 W DIVISION ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4515
Mailing Address - Country:US
Mailing Address - Phone:320-258-4440
Mailing Address - Fax:
Practice Address - Street 1:3333 W DIVISION ST
Practice Address - Street 2:STE 101
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4515
Practice Address - Country:US
Practice Address - Phone:320-258-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4398261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center