Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301002932 | MI |
N | 111NP0017X | Pediatric Chiropractor | 2301002932 | MI |
N | 111NR0400X | Rehabilitation Chiropractor | 2301002932 | MI |
N | 111NX0100X | Occupational Health | 2301002932 | MI |
N | 225100000X | Physical Therapist | 2301002932 | MI |
NPI | 1821154113 |
---|---|
Provider Name | Dr. Joseph Lupo |
First Address | Roseville, MI 48066-4803 |
Second Address | Roseville, MI 48066-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 09/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152233 | GREAT LAKES NUMBER (01) | MI |
2301002932 | LICENSE NUMBER (01) | MI |
40571 | HEALTH PLAN OF MICHIGAN (01) | MI |
4803238 | (05) | MI |
791350714 | RAILROAD MEDICARE (01) | |
950Q26288 | BLUE CROSS PROVIDER CODE (01) | MI |
950Q262880 | BLUE CARE NETWORK GROUP # (01) | MI |
JL002932 | LICENSE NUMBER (01) | MI |
T33708 | (02) | MI |