Provider Demographics
NPI:1205032570
Name:COPPOLA, DAVID (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COPPOLA
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 1:103400 OVERSEAS HWY
Mailing Address - Street 2:SUITE 241
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2834
Mailing Address - Country:US
Mailing Address - Phone:305-451-1819
Mailing Address - Fax:
Practice Address - Street 1:103400 OVERSEAS HWY
Practice Address - Street 2:SUITE 241
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2834
Practice Address - Country:US
Practice Address - Phone:305-451-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007249111N00000X
171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU59144Medicare UPIN