Healthcare Provider Details

I. General information

NPI: 1972921476
Provider Name (Legal Business Name): KOPPER CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 SMITH ST
KINGSBURG CA
93631-2217
US

IV. Provider business mailing address

1374 SMITH ST
KINGSBURG CA
93631-2217
US

V. Phone/Fax

Practice location:
  • Phone: 559-897-5801
  • Fax: 559-897-9134
Mailing address:
  • Phone: 559-897-5801
  • Fax: 559-897-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 20263
License Number StateCA

VIII. Authorized Official

Name: DR. TIMOTHY E KOPPER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 559-897-5801