Provider Demographics
NPI:1851457139
Name:LUPO, JEFFREY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
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:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008227225100000X, 111NX0100X, 111NP0017X, 111N00000X, 111NR0400X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23692OtherHEALTH PLAN OF MICHIGAN
MI139635OtherGREAT LAKES NUMBER
MI(NPI #)OtherCOVENTRY / OMNICARE
MI4423140Medicaid
MIP00011506OtherRAIL ROAD NUMBER
MIJL008227OtherLICENSE NUMBER
MI950G410360OtherBLUE CROSS PROVIDER CODE
MIP00011506OtherRAIL ROAD NUMBER
MIU83417Medicare UPIN