Provider Demographics
NPI:1265508584
Name:DONNA M COPERTINO PC
Entity Type:Organization
Organization Name:DONNA M COPERTINO PC
Other - Org Name:BACK IN ACTION CHIROPRACTIC REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:POYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-837-8854
Mailing Address - Street 1:151 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-1138
Mailing Address - Country:US
Mailing Address - Phone:610-837-8854
Mailing Address - Fax:610-837-7884
Practice Address - Street 1:151 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-1138
Practice Address - Country:US
Practice Address - Phone:610-837-8854
Practice Address - Fax:610-837-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007080L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU68684Medicare UPIN
PA066362Medicare PIN