Individual provider Active NPI

Michael Joseph Coppersmith, D.C.

  • Chiropractor
  • Princeton, WI
National Provider Identifier
1609946508
Registry record updated Apr 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3930-012 Issued in WI
Practice address
433 W Water St
Princeton, WI 54968-9148
Phone
(920) 295-6741
Fax
(920) 295-6741
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3930-012 WI Primary

Addresses

Primary practice location

433 W Water St
Princeton, WI 54968-9148

Mailing address

433 W Water St
PO Box 447
Princeton, WI 54968-9148
Phone (920) 295-6741

Other identifiers 2

IdentifierTypeStateIssuer
38950900MedicaidWI
000023001OtherWIMEDICARE PROVIDER #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3930-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Draeger Chiropractic Clinic, S.C. Chiropractor PastSince Apr 1, 1997 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239062400000",
    "number": "1609946508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 W WATER ST",
            "address_2": "PO BOX 447",
            "city": "PRINCETON",
            "state": "WI",
            "postal_code": "549689148",
            "telephone_number": "920-295-6741",
            "fax_number": "920-295-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 W WATER ST",
            "city": "PRINCETON",
            "state": "WI",
            "postal_code": "549689148",
            "telephone_number": "920-295-6741",
            "fax_number": "920-295-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPERSMITH",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2009-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3930-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38950900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "000023001",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.