Provider Demographics
NPI:1083754105
Name:COPESKEY, PAUL ROBERT (DC, CCFC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:COPESKEY
Suffix:
Gender:M
Credentials:DC, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 MANDEVILLE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1236
Mailing Address - Country:US
Mailing Address - Phone:310-471-7401
Mailing Address - Fax:
Practice Address - Street 1:12113 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2581
Practice Address - Country:US
Practice Address - Phone:310-447-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor