Provider Demographics
NPI:1841314614
Name:TRUPP, CARL JOHN III (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOHN
Last Name:TRUPP
Suffix:III
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 1:33523 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4117
Mailing Address - Country:US
Mailing Address - Phone:248-488-7500
Mailing Address - Fax:248-488-7501
Practice Address - Street 1:33523 8 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4117
Practice Address - Country:US
Practice Address - Phone:248-488-7500
Practice Address - Fax:248-488-7501
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL763106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H221290OtherBCBS
MI1003124652OtherGROUP NPI
MI1841314614OtherINDIVIDUAL NPI