Provider Demographics
NPI:1528064342
Name:CUPERUS, SARA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JEAN
Last Name:CUPERUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:JEAN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2380 TROOP DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4637
Mailing Address - Country:US
Mailing Address - Phone:320-255-0961
Mailing Address - Fax:320-258-4001
Practice Address - Street 1:2380 TROOP DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4637
Practice Address - Country:US
Practice Address - Phone:320-255-0961
Practice Address - Fax:320-258-4001
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4331111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN331J2CHOtherBCBS CLINIC PROVIDER #
MNC03940OtherMEDICARE CLINIC ID
MN332J9KLOtherBCBS INDIVIDUAL #
MN350056798OtherRAILROAD MEDICARE
MN777641100OtherMN HEALTH CARE PROGRAMS
MN331J2CHOtherBCBS CLINIC PROVIDER #
MNU94490Medicare UPIN