Provider Demographics
NPI:1942422126
Name:TRUPO, GARY CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHARLES
Last Name:TRUPO
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 1:19470 COASTAL HWY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-6127
Mailing Address - Country:US
Mailing Address - Phone:302-226-1234
Mailing Address - Fax:302-226-1883
Practice Address - Street 1:1092 S PONCE DE LEON BLVD STE K
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6018
Practice Address - Country:US
Practice Address - Phone:904-460-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001342111N00000X
MD02183111N00000X
FLCH10142111N00000X
DEF1-0000786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4579059OtherAETNA