Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301008650 | MI |
N | 111NI0013X | Independent Medical Examiner | 2301008650 | MI |
N | 111NP0017X | Pediatric Chiropractor | 2301008650 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 2301008650 | MI |
N | 111NX0100X | Occupational Health | 2301008650 | MI |
N | 225100000X | Physical Therapist | 2301008650 | MI |
NPI | 1568479350 |
---|---|
Provider Name | Dr. Jessica De Marie Lupo |
First Address | Roseville, MI 48066-4803 |
Second Address | Roseville, MI 48066-4803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152231 | GREAT LAKES HEALTH PLAN (01) | MI |
2301008650 | BCBS MI (01) | MI |
40734 | HEALTH PLAN OF MICHIGAN (01) | MI |
4803210 | (05) | MI |
JL008650 | BLUE CROSS BLUE SHIELD (01) | MI |
P00378726 | RAILROAD MEDICARE (01) | MI |
V00170 | (02) | MI |