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General NPI Number Information
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NPI Number | 1306495775
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Entity Type | Individual
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Provider Name | AUDRA ROSE KUOPPALA DC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 5050 WA STATE HWY 303 SUITE A101
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City | BREMERTON
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State | WA
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Zip | 98311
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Country | US
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Telephone | 360-627-7408
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Fax |
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Provider Business Mailing Address
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Address Line | 8202 NE STATE HIGHWAY 104 STE 105
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City | KINGSTON
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State | WA
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Zip | 98346-9454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH60987430
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License Number State | WA
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