Provider Demographics
NPI:1528423084
Name:TUPMAN, STEPHEN PARIS (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PARIS
Last Name:TUPMAN
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 1:4105 HUMBERT RD
Mailing Address - Street 2:# 102
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-7161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4105 HUMBERT RD STE 102
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7161
Practice Address - Country:US
Practice Address - Phone:618-463-1600
Practice Address - Fax:618-463-1624
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor