Provider Demographics
NPI:1154482891
Name:MICHAEL A. COPPOLA
Entity Type:Organization
Organization Name:MICHAEL A. COPPOLA
Other - Org Name:AMBLER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-643-2250
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0509
Mailing Address - Country:US
Mailing Address - Phone:215-643-2250
Mailing Address - Fax:215-643-7913
Practice Address - Street 1:332 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3525
Practice Address - Country:US
Practice Address - Phone:215-643-2250
Practice Address - Fax:215-643-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003216L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA434112Medicare ID - Type Unspecified