Provider Demographics
NPI:1801024591
Name:KUPERUS, RACHAEL ANN (DC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:KUPERUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 NEW LA GRANGE RD
Mailing Address - Street 2:STE 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4813
Mailing Address - Country:US
Mailing Address - Phone:502-426-6715
Mailing Address - Fax:
Practice Address - Street 1:105 LYNDON LN
Practice Address - Street 2:STE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5550
Practice Address - Country:US
Practice Address - Phone:502-426-6715
Practice Address - Fax:502-426-6716
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00672900111N00000X
KY5228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor