Provider Demographics
NPI:1902949423
Name:BUPP, BRANDON D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:D
Last Name:BUPP
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 1:201 GREAT OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9430
Mailing Address - Country:US
Mailing Address - Phone:330-336-9500
Mailing Address - Fax:330-336-3377
Practice Address - Street 1:201 GREAT OAKS TRL
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9430
Practice Address - Country:US
Practice Address - Phone:330-336-9500
Practice Address - Fax:330-336-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor