Provider Demographics
NPI:1821154113
Name:LUPO, JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:LUPO
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 1:27850 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4803
Mailing Address - Country:US
Mailing Address - Phone:586-772-5876
Mailing Address - Fax:586-772-1122
Practice Address - Street 1:27850 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4803
Practice Address - Country:US
Practice Address - Phone:586-772-5876
Practice Address - Fax:586-772-1122
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002932225100000X, 111N00000X, 111NX0100X, 111NP0017X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
791350714OtherRAILROAD MEDICARE
MI2301002932OtherLICENSE NUMBER
MI950Q262880OtherBLUE CARE NETWORK GROUP #
MI152233OtherGREAT LAKES NUMBER
MI40571OtherHEALTH PLAN OF MICHIGAN
MI950Q26288OtherBLUE CROSS PROVIDER CODE
MIJL002932OtherLICENSE NUMBER
MI4803238Medicaid
MIJL002932OtherLICENSE NUMBER
MI2301002932OtherLICENSE NUMBER
MI0N23370Medicare ID - Type Unspecified