Provider Demographics
NPI:1033505458
Name:COPPLE, JEREMY DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DENNIS
Last Name:COPPLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 WESTPOINT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2128
Mailing Address - Country:US
Mailing Address - Phone:313-585-1517
Mailing Address - Fax:
Practice Address - Street 1:22615 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2115
Practice Address - Country:US
Practice Address - Phone:313-585-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor