Benjamin Eugene Pupo, DC

Primary specialty

Neurology ChiropractorTaxonomy code 111NN0400X

License

8961561 Issued in ID

Practice address

410 E Sherman Ave Ste 209
Coeur D Alene, ID 83814-2761

Phone

(509) 993-9470

NPI assigned

Apr 5, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1982283115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E SHERMAN AVE STE 209",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142761",
            "telephone_number": "208-751-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E SHERMAN AVE STE 209",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142761",
            "telephone_number": "509-993-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUPO",
        "first_name": "BENJAMIN",
        "middle_name": "EUGENE",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-05",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "MN",
            "license": "6842",
            "primary": false
        },
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "ID",
            "license": "8961561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peter R Purrington, MD
• Vadim P Pustynovich, FNP-C
• Crystal Lee Pyrak, MD
• Jana M Qualls, FNP

• Neurology Chiropractor in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Neurology Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.