Provider Demographics
NPI:1942531405
Name:KOPCIO, JORDAN C (DC NMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:C
Last Name:KOPCIO
Suffix:
Gender:M
Credentials:DC NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1766
Mailing Address - Country:US
Mailing Address - Phone:480-970-0000
Mailing Address - Fax:480-970-0003
Practice Address - Street 1:2164 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1766
Practice Address - Country:US
Practice Address - Phone:480-970-0000
Practice Address - Fax:480-970-0003
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8095111N00000X
AZ13-1355175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor