Provider Demographics
NPI:1053516245
Name:LUPO, ROBERT CARL (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:LUPO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:CARL
Other - Last Name:LUPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:15804 DAWSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1320
Mailing Address - Country:US
Mailing Address - Phone:813-978-0591
Mailing Address - Fax:
Practice Address - Street 1:14522 UNIVERSITY POINT PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5425
Practice Address - Country:US
Practice Address - Phone:813-978-0020
Practice Address - Fax:813-972-9024
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH5346OtherLICENSE #
FL22031OtherBCBS
FL1902810963OtherNPI GROUP #
FLT84275Medicare UPIN
FL22031OtherBCBS