Provider Demographics
NPI:1598854218
Name:ZUPANCIC, RICHARD J SR (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ZUPANCIC
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2336
Mailing Address - Country:US
Mailing Address - Phone:502-938-8918
Mailing Address - Fax:
Practice Address - Street 1:815 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2336
Practice Address - Country:US
Practice Address - Phone:502-938-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81000092A171100000X
IN08002249A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
224090BMedicare ID - Type Unspecified
INU86694Medicare UPIN