Provider Demographics
NPI:1639221195
Name:HUPPERT, MICHAEL I (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:HUPPERT
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 1:920 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1334
Mailing Address - Country:US
Mailing Address - Phone:706-546-7700
Mailing Address - Fax:706-548-4518
Practice Address - Street 1:920 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1334
Practice Address - Country:US
Practice Address - Phone:706-546-7700
Practice Address - Fax:706-548-4518
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor