Provider Demographics
NPI:1053535393
Name:SIUPIK, KAREN ELLEN
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELLEN
Last Name:SIUPIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43423 JOY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2053
Mailing Address - Country:US
Mailing Address - Phone:734-354-9900
Mailing Address - Fax:734-354-8755
Practice Address - Street 1:43423 JOY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2053
Practice Address - Country:US
Practice Address - Phone:734-354-9900
Practice Address - Fax:734-354-8755
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M93910Medicare PIN
MI0H20154Medicare UPIN