Provider Demographics
NPI:1629077417
Name:DARA, RUPA (DC)
Entity Type:Individual
Prefix:MS
First Name:RUPA
Middle Name:
Last Name:DARA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2813
Mailing Address - Country:US
Mailing Address - Phone:360-373-3026
Mailing Address - Fax:360-373-5301
Practice Address - Street 1:1018 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2813
Practice Address - Country:US
Practice Address - Phone:360-373-3026
Practice Address - Fax:360-373-5301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
122883OtherLTI
DA5429OtherREGENCE
DA5429OtherREGENCE
U72S63Medicare UPIN