Provider Demographics
NPI:1881080067
Name:KOPAS, CORY MICHAEL (DC)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:MICHAEL
Last Name:KOPAS
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 1:130 26TH STREET NW
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060
Mailing Address - Country:US
Mailing Address - Phone:507-451-0051
Mailing Address - Fax:507-451-0733
Practice Address - Street 1:130 26TH STREET NW
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060
Practice Address - Country:US
Practice Address - Phone:507-451-0051
Practice Address - Fax:507-451-0733
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor