Provider Demographics
NPI:1710281779
Name:KOPP, KRISTA ANN (DC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:KOPP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 NICOLLET AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-2568
Mailing Address - Country:US
Mailing Address - Phone:763-639-7160
Mailing Address - Fax:
Practice Address - Street 1:6110 NICOLLET AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-2568
Practice Address - Country:US
Practice Address - Phone:763-639-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor