Provider Demographics
NPI:1982941399
Name:SCHUPP CHIROPRACTIC AND SPORTS INJURIES LLC
Entity Type:Organization
Organization Name:SCHUPP CHIROPRACTIC AND SPORTS INJURIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SCHUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-399-1362
Mailing Address - Street 1:2110 FORDEM AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4610
Mailing Address - Country:US
Mailing Address - Phone:608-244-7447
Mailing Address - Fax:
Practice Address - Street 1:2110 FORDEM AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4610
Practice Address - Country:US
Practice Address - Phone:608-244-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4908-12111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty