Provider Demographics
NPI:1629243787
Name:TOM KOPSCH & ASSOCIATES,INC
Entity Type:Organization
Organization Name:TOM KOPSCH & ASSOCIATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-549-0140
Mailing Address - Street 1:32268 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0944
Mailing Address - Country:US
Mailing Address - Phone:248-549-0140
Mailing Address - Fax:248-549-5665
Practice Address - Street 1:32268 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0944
Practice Address - Country:US
Practice Address - Phone:248-549-0140
Practice Address - Fax:248-549-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITK005961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM65460OtherUPIN# U35807
950F31559OtherBCBSM
U35807OtherUPIN
MI4547620Medicaid
MIOM65460Medicare PIN