Provider Demographics
NPI:1114382462
Name:COPPLE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COPPLE CHIROPRACTIC LLC
Other - Org Name:ACTIVATE YOUR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:H
Authorized Official - Last Name:COPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-676-9100
Mailing Address - Street 1:3915 BECK ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4909
Mailing Address - Country:US
Mailing Address - Phone:816-676-9100
Mailing Address - Fax:816-390-9777
Practice Address - Street 1:3915 BECK ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4909
Practice Address - Country:US
Practice Address - Phone:816-676-9100
Practice Address - Fax:816-390-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015040834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty