Provider Demographics
NPI:1881736197
Name:HUPPERT, CAROLYN ANN (DC, MUAC)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:HUPPERT
Suffix:
Gender:F
Credentials:DC, MUAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 PLAZA CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340
Mailing Address - Country:US
Mailing Address - Phone:623-935-1999
Mailing Address - Fax:623-535-0848
Practice Address - Street 1:549 E PLAZA CIR STE B
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4918
Practice Address - Country:US
Practice Address - Phone:623-935-1999
Practice Address - Fax:623-535-0848
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0250020OtherBLUE CROSS BLUE SHIELD
024995Medicare UPIN
AZDC4819Medicare ID - Type UnspecifiedMEDICARE ID