Provider Demographics
NPI:1104916162
Name:COPELAND, CHARLES EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 EDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1423
Mailing Address - Country:US
Mailing Address - Phone:502-479-7948
Mailing Address - Fax:
Practice Address - Street 1:1525 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1109
Practice Address - Country:US
Practice Address - Phone:502-454-5000
Practice Address - Fax:502-454-5225
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85043842Medicaid
U65930Medicare UPIN
KY85043842Medicaid