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Individual

DR. JEFFREY JOSEPH LUPO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
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
2301008227
MI
111NI0013X
Independent Medical Examiner Chiropractor
2301008227
MI
111NP0017X
Pediatric Chiropractor
2301008227
MI
111NR0400X
Rehabilitation Chiropractor
2301008227
MI
111NX0100X
Occupational Health Chiropractor
2301008227
MI
225100000X
Physical Therapist
2301008227
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
(NPI #)
COVENTRY / OMNICARE
MI
01
139635
GREAT LAKES NUMBER
MI
01
23692
HEALTH PLAN OF MICHIGAN
MI
05
4423140
MI
01
950G410360
BLUE CROSS PROVIDER CODE
MI
01
JL008227
LICENSE NUMBER
MI
01
P00011506
RAIL ROAD NUMBER
MI
Enumeration date
12/29/2006
Last updated
06/08/2011
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