1881736197 NPI number — DR. CAROLYN ANN HUPPERT D.C., M.U.A.C.

Table of content: DR. CAROLYN ANN HUPPERT D.C., M.U.A.C. (NPI 1881736197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881736197 NPI number — DR. CAROLYN ANN HUPPERT D.C., M.U.A.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUPPERT
Provider First Name:
CAROLYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., M.U.A.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881736197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
549 PLAZA CIRCLE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LITCHFIELD PARK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-935-1999
Provider Business Mailing Address Fax Number:
623-535-0848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
549 E PLAZA CIR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITCHFIELD PARK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85340-4918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-935-1999
Provider Business Practice Location Address Fax Number:
623-535-0848
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4819 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0250020 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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