Provider Demographics
NPI:1639291511
Name:KOEPFLER FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:KOEPFLER FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEPFLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-279-2845
Mailing Address - Street 1:352 S WILLOWBROOK RD
Mailing Address - Street 2:STE D
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8856
Mailing Address - Country:US
Mailing Address - Phone:517-279-2845
Mailing Address - Fax:517-279-2847
Practice Address - Street 1:352 S WILLOWBROOK RD
Practice Address - Street 2:STE D
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8856
Practice Address - Country:US
Practice Address - Phone:517-279-2845
Practice Address - Fax:517-279-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4949804Medicaid
MID02602Medicare UPIN
MI0P26110Medicare ID - Type UnspecifiedGROUP