Provider Demographics
NPI:1972921476
Name:KOPPER CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:KOPPER CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-897-5801
Mailing Address - Street 1:1374 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2217
Mailing Address - Country:US
Mailing Address - Phone:559-897-5801
Mailing Address - Fax:559-897-9134
Practice Address - Street 1:1374 SMITH ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2217
Practice Address - Country:US
Practice Address - Phone:559-897-5801
Practice Address - Fax:559-897-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT95702Medicare UPIN