Provider Demographics
NPI:1760475743
Name:DUPRIEST, CECIL MICHAEL (PT, DPT, DC)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:MICHAEL
Last Name:DUPRIEST
Suffix:
Gender:M
Credentials:PT, DPT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W 7TH (117/LR)
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-257-6191
Mailing Address - Fax:501-257-6419
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6191
Practice Address - Fax:501-257-6419
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR515225100000X
AR1125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1421619OtherUNITED HEALTHCARE
ARP00135320OtherMEDICARE RAILROAD
AR1334497OtherUNITED HEALTHCARE
AR14376000000OtherQUALCHOICE
AR1421619OtherUNITED HEALTHCARE
ARP00135320OtherMEDICARE RAILROAD
T69479Medicare UPIN