Provider Demographics
NPI:1205201340
Name:COPPLE, JOHNATHON (DC)
Entity Type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:
Last Name:COPPLE
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 1:3915 BECK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT 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 RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT 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
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015040834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor