Provider Demographics
NPI:1861767238
Name:KAPUT, EDWIN RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:RICHARD
Last Name:KAPUT
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 1:5092 W VIENNA RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2803
Mailing Address - Country:US
Mailing Address - Phone:586-604-3253
Mailing Address - Fax:810-686-3124
Practice Address - Street 1:5092 W VIENNA RD
Practice Address - Street 2:SUITE H
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2803
Practice Address - Country:US
Practice Address - Phone:586-604-3253
Practice Address - Fax:810-686-3124
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor