Provider Demographics
NPI:1730753153
Name:STUPAK CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:STUPAK CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:STUPAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-531-7766
Mailing Address - Street 1:1788 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6074
Mailing Address - Country:US
Mailing Address - Phone:734-531-7766
Mailing Address - Fax:855-492-1570
Practice Address - Street 1:2311 E STADIUM BLVD STE 109-A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4833
Practice Address - Country:US
Practice Address - Phone:734-531-7766
Practice Address - Fax:855-492-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty