Provider Demographics
NPI:1184706236
Name:RUPOLO, JOHN G (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:RUPOLO
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 1:148 TULIP AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2705
Mailing Address - Country:US
Mailing Address - Phone:516-354-4310
Mailing Address - Fax:516-328-7019
Practice Address - Street 1:148 TULIP AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2705
Practice Address - Country:US
Practice Address - Phone:516-354-4310
Practice Address - Fax:516-328-7019
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1883X-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX01701OtherBLUE CROSS
NYX01701OtherBLUE CROSS