Provider Demographics
NPI:1588741839
Name:CUPP, JASON EUGENE (DC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:EUGENE
Last Name:CUPP
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 1:52 STURGIS CORNER DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-5617
Mailing Address - Country:US
Mailing Address - Phone:319-688-2974
Mailing Address - Fax:
Practice Address - Street 1:52 STURGIS CORNER DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5617
Practice Address - Country:US
Practice Address - Phone:319-688-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1181495Medicaid
IAI1672Medicare ID - Type Unspecified