Healthcare Provider Details

I. General information

NPI: 1043423825
Provider Name (Legal Business Name): MICHAEL ANDREW KOPLEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 CAPITOLA ROAD
CAPITOLA CA
95010
US

IV. Provider business mailing address

755 14TH AVE APT 410
SANTA CRUZ CA
95062
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-6450
  • Fax:
Mailing address:
  • Phone: 831-465-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCA18846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number18846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: