Organization Active NPI

Kuperus Family Chiropractic PSC

  • Chiropractor
  • Louisville, KY
National Provider Identifier
1639433295
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5228 Issued in KY
Legal business name
KUPERUS FAMILY CHIROPRACTIC PSC
Practice address
105 Lyndon LN
Suite 102
Louisville, KY 40222-5550
Phone
(502) 426-6715
Fax
(502) 426-6716
NPI assigned
Jun 28, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rachael A Kuperus, DCNPI 1801024591
Title
President
Phone
(502) 426-6715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 5228 KY Primary

Addresses

Primary practice location

105 Lyndon LN
Suite 102
Louisville, KY 40222-5550

Mailing address

105 Lyndon LN
Suite 102
Louisville, KY 40222-5550
Phone (502) 426-6715

Other identifiers 2

IdentifierTypeStateIssuer
200977090MedicaidIN
7100131790MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120725001083 KY Part B Supplier - Clinic/Group Practice 9436315009 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory

Locations

7410 New La Grange Rd
Ste 202
Louisville, KY 40222
Phone (502) 425-6200

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340841600000",
    "number": "1639433295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 LYNDON LN",
            "address_2": "SUITE 102",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225550",
            "telephone_number": "502-426-6715",
            "fax_number": "502-426-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 LYNDON LN",
            "address_2": "SUITE 102",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225550",
            "telephone_number": "502-426-6715",
            "fax_number": "502-426-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUPERUS FAMILY CHIROPRACTIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-28",
        "last_updated": "2012-06-28",
        "status": "A",
        "authorized_official_last_name": "KUPERUS",
        "authorized_official_first_name": "RACHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-426-6715",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "5228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200977090",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100131790",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.