Individual
DR. JESSICA DE MARIE LUPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
27850 GRATIOT AVE, ROSEVILLE, MI 48066-4803
(586) 772-5876
(586) 772-1122
Mailing address
27850 GRATIOT AVE, ROSEVILLE, MI 48066-4803
(586) 772-5876
(586) 772-1122
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008650
MI
111NI0013X
Independent Medical Examiner Chiropractor
2301008650
MI
111NP0017X
Pediatric Chiropractor
2301008650
MI
111NR0400X
Rehabilitation Chiropractor
2301008650
MI
111NX0100X
Occupational Health Chiropractor
2301008650
MI
225100000X
Physical Therapist
2301008650
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152231
GREAT LAKES HEALTH PLAN
MI
01
—
2301008650
BCBS MI
MI
01
—
40734
HEALTH PLAN OF MICHIGAN
MI
05
—
4803210
—
MI
01
—
JL008650
BLUE CROSS BLUE SHIELD
MI
01
—
P00378726
RAILROAD MEDICARE
MI
Enumeration date
08/02/2006
Last updated
06/08/2011
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