Provider Demographics
NPI:1063877280
Name:KUPPER, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KUPPER
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 1:2212 CAROL VIEW DR APT C302
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1952
Mailing Address - Country:US
Mailing Address - Phone:949-303-3881
Mailing Address - Fax:
Practice Address - Street 1:2212 CAROL VIEW DR APT C302
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1952
Practice Address - Country:US
Practice Address - Phone:949-303-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor