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General NPI Number Information
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NPI Number | 1023254653
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Entity Type | Organization
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Legal Business Name | COPPOLA CHIROPRACTIC INC.
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Dates
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Enumeration Date | 01/03/2009
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 380 CAMINO DE ESTRELLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4859
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Country | US
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Telephone | 949-487-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 380 CAMINO DE ESTRELLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4859
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Country | US
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Telephone | 949-487-1231
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ANTHONY COPPOLA JR.
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Credential | D.C.
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Telephone | 949-487-1231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC 30393
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License Number State | CA
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