Provider Demographics
NPI:1568596187
Name:KOPRIVA, KEVIN L. L (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN L.
Middle Name:L
Last Name:KOPRIVA
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 1:6 CALLE MEDICO
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4761
Mailing Address - Country:US
Mailing Address - Phone:505-982-2553
Mailing Address - Fax:
Practice Address - Street 1:6 CALLE MEDICO
Practice Address - Street 2:SUITE #1
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4761
Practice Address - Country:US
Practice Address - Phone:505-982-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor