Provider Demographics
NPI:1720130388
Name:LUPLOW, DARYLE NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:DARYLE
Middle Name:NATHAN
Last Name:LUPLOW
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 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1022
Mailing Address - Country:US
Mailing Address - Phone:585-591-2225
Mailing Address - Fax:585-591-0515
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1022
Practice Address - Country:US
Practice Address - Phone:585-591-2225
Practice Address - Fax:585-591-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX08462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB5707Medicare ID - Type Unspecified