Individual provider Active NPI

Eric Dax Rupp, D.C.

  • Sports Physician Chiropractor
  • Arvada, CO
National Provider Identifier
1679502090
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
5883 Issued in CO
Practice address
8410 Wadsworth Blvd
Suite a
Arvada, CO 80003-0917
Phone
(303) 425-9557
Fax
(303) 425-3399
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 5883 CO Primary

Addresses

Primary practice location

8410 Wadsworth Blvd
Suite a
Arvada, CO 80003-0917

Mailing address

9734 Iris St
Westminster, CO 80021-4266
Phone (303) 456-6351

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070201000550 CO Practitioner - Chiropractic 0749282820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 2006
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4125 Snowbird Ave
Broomfield, CO 80020-7946
Phone (303) 465-4400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5883COMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pure Life Chiropractic and Wellness, PC PastSince Jul 2, 2016 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1679502090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9734 IRIS ST",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800214266",
            "telephone_number": "303-456-6351",
            "fax_number": "303-425-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8410 WADSWORTH BLVD",
            "address_2": "SUITE A",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800030917",
            "telephone_number": "303-425-9557",
            "fax_number": "303-425-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUPP",
        "first_name": "ERIC",
        "middle_name": "DAX",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CO",
            "license": "5883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arvada, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.