Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC004684L | PA |
NPI | 1003855222 |
---|---|
Provider Name | Dr. Gerald Coppola |
First Address | Pottstown, PA 19465-9649 |
Second Address | Pottstown, PA 19465-9649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 28/10/2009 |