Provider Demographics
NPI:1518086818
Name:MELISSA ANN KOPP, DC PLLC
Entity Type:Organization
Organization Name:MELISSA ANN KOPP, DC PLLC
Other - Org Name:VERDE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-639-1700
Mailing Address - Street 1:1632 E COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4692
Mailing Address - Country:US
Mailing Address - Phone:928-639-1700
Mailing Address - Fax:928-639-2001
Practice Address - Street 1:1632 E COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4692
Practice Address - Country:US
Practice Address - Phone:928-639-1700
Practice Address - Fax:928-639-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74557OtherMEDICARE PTAN
AZP00166822OtherMEDICARE RAILROAD
AZZ74557Medicare ID - Type Unspecified