Healthcare Provider Details

I. General information

NPI: 1639380959
Provider Name (Legal Business Name): COPLEN CHIROPRACTIC WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E BARNETT RD
MEDFORD OR
97504-8249
US

IV. Provider business mailing address

1801 E BARNETT RD
MEDFORD OR
97504-8249
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-2020
  • Fax: 541-773-3939
Mailing address:
  • Phone: 541-773-2020
  • Fax: 541-773-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27-1777
License Number StateOR

VIII. Authorized Official

Name: JAN KAY COPLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-773-2020