Provider Demographics
NPI:1801910591
Name:TRUPP FAMILY CARE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:TRUPP FAMILY CARE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
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:734-261-5677
Mailing Address - Street 1:15614 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2852
Mailing Address - Country:US
Mailing Address - Phone:734-261-5677
Mailing Address - Fax:734-261-5688
Practice Address - Street 1:15614 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2852
Practice Address - Country:US
Practice Address - Phone:734-261-5677
Practice Address - Fax:734-261-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL763106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H221290OtherBCBS
MI950H221290OtherBCBS
MI0N78500Medicare ID - Type Unspecified