Provider Demographics
NPI:1467780965
Name:KOPSIAN, JAMES JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:KOPSIAN
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 1:765 ELA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2339
Mailing Address - Country:US
Mailing Address - Phone:847-550-1115
Mailing Address - Fax:847-550-1117
Practice Address - Street 1:765 ELA RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2339
Practice Address - Country:US
Practice Address - Phone:847-550-1115
Practice Address - Fax:847-550-1117
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor