Provider Demographics
NPI:1164550547
Name:COPPES CHIROPRACTIC PC
Entity Type:Organization
Organization Name:COPPES CHIROPRACTIC PC
Other - Org Name:ADVANCE CHIROPRACTIC CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:COPPES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-752-1460
Mailing Address - Street 1:3115 AGENCY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1908
Mailing Address - Country:US
Mailing Address - Phone:319-752-1460
Mailing Address - Fax:319-752-1461
Practice Address - Street 1:3115 AGENCY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1908
Practice Address - Country:US
Practice Address - Phone:319-752-1460
Practice Address - Fax:319-752-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADD6644OtherRR MEDICARE
IA0462218Medicaid
IA0462218Medicaid