Provider Demographics
NPI:1003124652
Name:TRUPP TRANSFORMATION HEALTH
Entity type:Organization
Organization Name:TRUPP TRANSFORMATION HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TRUPP
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:810-650-4952
Mailing Address - Street 1:18444 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3588
Mailing Address - Country:US
Mailing Address - Phone:248-488-7500
Mailing Address - Fax:248-488-7501
Practice Address - Street 1:18444 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3588
Practice Address - Country:US
Practice Address - Phone:248-488-7500
Practice Address - Fax:248-488-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU97006Medicare UPIN
MION78500Medicare PIN