Provider Demographics
NPI:1073029377
Name:KUOPPALA, COLLIN (DC)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:KUOPPALA
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 1:8840 OLD SEWARD HWY STE E
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2000
Mailing Address - Country:US
Mailing Address - Phone:907-743-0124
Mailing Address - Fax:907-346-5256
Practice Address - Street 1:2201 DUNN ST STE 2
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9480
Practice Address - Country:US
Practice Address - Phone:907-796-3333
Practice Address - Fax:907-796-3334
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK128097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor