Provider Demographics
NPI:1801071162
Name:CUPPLES, KRANE T (DC)
Entity type:Individual
Prefix:DR
First Name:KRANE
Middle Name:T
Last Name:CUPPLES
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 1:1307 W WASHINGTON ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1001
Mailing Address - Country:US
Mailing Address - Phone:815-732-2826
Mailing Address - Fax:815-732-7617
Practice Address - Street 1:1307 W WASHINGTON ST
Practice Address - Street 2:SUITE 115
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1001
Practice Address - Country:US
Practice Address - Phone:815-732-2826
Practice Address - Fax:815-732-7617
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor