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General NPI Number Information
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NPI Number | 1003097452
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Entity Type | Organization
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Legal Business Name | COPELAND CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 113 OLD STATE RD STE 202
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City | ELLISVILLE
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State | MO
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Zip | 63021-2042
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Country | US
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Telephone | 636-386-6200
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Fax | 636-386-8849
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Provider Business Mailing Address
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Address Line | 113 OLD STATE RD STE 202
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City | ELLISVILLE
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State | MO
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Zip | 63021-2042
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Country | US
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Telephone | 636-386-6200
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Fax | 636-386-8849
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES S COPELAND
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Credential | DC
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Telephone | 636-386-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 005170
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License Number State | MO
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