Provider Demographics
NPI:1588713572
Name:COPPOLA, AMBER ROSE (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:ROSE
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 LOCUST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3727
Mailing Address - Country:US
Mailing Address - Phone:215-732-3450
Mailing Address - Fax:
Practice Address - Street 1:1521 LOCUST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3727
Practice Address - Country:US
Practice Address - Phone:215-732-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00650100111N00000X
PADC010022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor