Provider Demographics
NPI:1124048665
Name:CHUPPE, GREGORY P (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:CHUPPE
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 1:1936 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1914
Mailing Address - Country:US
Mailing Address - Phone:701-258-0029
Mailing Address - Fax:701-258-0826
Practice Address - Street 1:1936 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1914
Practice Address - Country:US
Practice Address - Phone:701-258-0029
Practice Address - Fax:701-258-0826
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4249Medicare ID - Type Unspecified
NDT89011Medicare UPIN