Provider Demographics
NPI:1891087961
Name:RUPPERT, ALLEN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MICHAEL
Last Name:RUPPERT
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 1:1924 WREN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-405-7877
Mailing Address - Fax:772-293-9163
Practice Address - Street 1:4842 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2243
Practice Address - Country:US
Practice Address - Phone:772-405-7877
Practice Address - Fax:772-293-9163
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor