Michael Anthony Coppola Jr., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC 30393 Issued in CA

Practice address

655 Camino de Los Mares
Suite 121
San Clemente, CA 92673-2809

Phone

(949) 487-1231

Fax

(949) 487-0221

NPI assigned

Sep 25, 2007

Last updated

Sep 25, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

• Coppola Chiropractic Inc.

  dba Active Life Healthcare

  • Clinic/Center
  • San Clemente, CA
  • NPI 1023254653
  Authorized official Same address or phone

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190678400000",
    "number": "1699962423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 CAMINO DE LOS MARES",
            "address_2": "SUITE 121",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732809",
            "telephone_number": "949-487-1231",
            "fax_number": "949-487-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 CAMINO DE LOS MARES",
            "address_2": "SUITE 121",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732809",
            "telephone_number": "949-487-1231",
            "fax_number": "949-487-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOLA",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2007-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC 30393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Eve Conlin, OTR/L
• Alyssa Carolyn Conrad
• Contemporary Healthcare Medical Group, Inc. (CHMG)
• Christopher Reed Cook, R.D.H
• Coppola Chiropractic Inc. (Active Life Healthcare)
• Jay Cost, PT
• Costa Chiropractic Corporation (Costa Lifestlye Medicine)
• Counseling Solutions
• Regina Fridella Cousineau, RDN
• Tracie Louise Covey Borchard, LMFT

• Chiropractor in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; 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.