Provider Demographics
NPI:1467023838
Name:KOPINSKI, CARLY AMELIA (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:AMELIA
Last Name:KOPINSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:AMELIA
Other - Last Name:SWANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17628 N EAGLE RIVER LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8201
Mailing Address - Country:US
Mailing Address - Phone:715-451-4809
Mailing Address - Fax:
Practice Address - Street 1:17628 N EAGLE RIVER LOOP RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8201
Practice Address - Country:US
Practice Address - Phone:715-451-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor