Provider Demographics
NPI:1669591004
Name:COPP, ROBERT M (DC CACU)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:COPP
Suffix:
Gender:M
Credentials:DC CACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2431
Mailing Address - Country:US
Mailing Address - Phone:850-769-3602
Mailing Address - Fax:850-785-5822
Practice Address - Street 1:1138 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2431
Practice Address - Country:US
Practice Address - Phone:850-769-3602
Practice Address - Fax:850-785-5822
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22619Medicare ID - Type UnspecifiedDC CACU