Provider Demographics
NPI:1205971884
Name:COPPOLA, ROBERT ANTHONY JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:COPPOLA
Suffix:JR
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 1:1481 ROLLING MEADOWS CT.
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091
Mailing Address - Country:US
Mailing Address - Phone:859-283-0057
Mailing Address - Fax:859-727-6878
Practice Address - Street 1:4035 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:KY
Practice Address - Zip Code:41018-1813
Practice Address - Country:US
Practice Address - Phone:859-727-6888
Practice Address - Fax:859-727-6878
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4892111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician