Provider Demographics
NPI:1679502090
Name:RUPP, ERIC DAX (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAX
Last Name:RUPP
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 1:9734 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4266
Mailing Address - Country:US
Mailing Address - Phone:303-456-6351
Mailing Address - Fax:303-425-3399
Practice Address - Street 1:8410 WADSWORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0917
Practice Address - Country:US
Practice Address - Phone:303-425-9557
Practice Address - Fax:303-425-3399
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5883111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807152Medicare PIN