Provider Demographics
NPI:1457469926
Name:KOPPER, TIMOTHY E (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:KOPPER
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 1:1374 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2217
Mailing Address - Country:US
Mailing Address - Phone:559-897-5801
Mailing Address - Fax:559-897-9134
Practice Address - Street 1:1374 SMITH ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2217
Practice Address - Country:US
Practice Address - Phone:559-897-5801
Practice Address - Fax:559-897-9134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0202631Medicaid
CADC0202631Medicaid
T95702Medicare UPIN