Provider Demographics
NPI:1316156581
Name:RUPERT, BECKY ROSE (ND, CNC, CCH)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:ROSE
Last Name:RUPERT
Suffix:
Gender:F
Credentials:ND, CNC, CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12931 N. ELYRIA RD.
Mailing Address - Street 2:PO BOX 535
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-9796
Mailing Address - Country:US
Mailing Address - Phone:419-853-3805
Mailing Address - Fax:419-853-4741
Practice Address - Street 1:12931 N. ELYRIA RD.
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-9796
Practice Address - Country:US
Practice Address - Phone:419-853-3805
Practice Address - Fax:419-853-4741
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001120141175F00000X
175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No175F00000XOther Service ProvidersNaturopath