Provider Demographics
NPI:1700875531
Name:RUPP, GERALD WANE (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WANE
Last Name:RUPP
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 1:314 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1259
Mailing Address - Country:US
Mailing Address - Phone:651-437-9411
Mailing Address - Fax:
Practice Address - Street 1:314 2ND ST E
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1259
Practice Address - Country:US
Practice Address - Phone:651-437-9411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2847111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41P63RUMedicare UPIN