Provider Demographics
NPI:1629204755
Name:RUPPERT, NICHOLAS RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RYAN
Last Name:RUPPERT
Suffix:
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 1:2622 NASA PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3447
Mailing Address - Country:US
Mailing Address - Phone:832-864-2714
Mailing Address - Fax:832-864-2715
Practice Address - Street 1:2622 NASA PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3459
Practice Address - Country:US
Practice Address - Phone:832-864-2714
Practice Address - Fax:832-864-2715
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor