Provider Demographics
NPI:1154438018
Name:KOPSCH, THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:KOPSCH
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 1:32268 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0944
Mailing Address - Country:US
Mailing Address - Phone:248-549-0140
Mailing Address - Fax:248-549-5665
Practice Address - Street 1:32268 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0944
Practice Address - Country:US
Practice Address - Phone:248-549-0140
Practice Address - Fax:248-549-5665
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITK005961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4547620Medicaid
MIOM65460Medicare ID - Type Unspecified
MIU35807Medicare UPIN