Provider Demographics
NPI:1750325064
Name:COPERTINO, DONNA MARIE (DC, CSCS, DACRB)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:COPERTINO
Suffix:
Gender:F
Credentials:DC, CSCS, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-1138
Mailing Address - Country:US
Mailing Address - Phone:610-837-8854
Mailing Address - Fax:610-837-7884
Practice Address - Street 1:151 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014
Practice Address - Country:US
Practice Address - Phone:610-837-8854
Practice Address - Fax:610-837-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007080111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066362Medicare ID - Type Unspecified
PAU68684Medicare UPIN