Provider Demographics
NPI:1134179351
Name:COPP, BLAIR W (DC)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:W
Last Name:COPP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7789 W BELL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3802
Mailing Address - Country:US
Mailing Address - Phone:623-412-7877
Mailing Address - Fax:623-979-8049
Practice Address - Street 1:7789 W BELL RD STE 102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3802
Practice Address - Country:US
Practice Address - Phone:623-412-7877
Practice Address - Fax:623-979-8049
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor