Provider Demographics
NPI:1326331323
Name:COPP CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COPP CHIROPRACTIC LLC
Other - Org Name:HEALING TOUCH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-383-9309
Mailing Address - Street 1:22225 N 102ND LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2656
Mailing Address - Country:US
Mailing Address - Phone:480-383-9309
Mailing Address - Fax:623-322-3045
Practice Address - Street 1:10015 W ROYAL OAK RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3164
Practice Address - Country:US
Practice Address - Phone:480-383-9309
Practice Address - Fax:623-322-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147019OtherPTAN