Provider Demographics
NPI:1942412309
Name:KOPP, JEFFREY V (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:V
Last Name:KOPP
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 1:2890 BRANDON CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-6225
Mailing Address - Country:US
Mailing Address - Phone:319-373-5611
Mailing Address - Fax:
Practice Address - Street 1:1935 1ST AVE SE
Practice Address - Street 2:SUITE 3
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5332
Practice Address - Country:US
Practice Address - Phone:319-294-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor