Individual
AUDRA ROSE KUOPPALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
5050 WA STATE HWY 303, SUITE A101, BREMERTON, WA 98311
(360) 627-7408
Mailing address
8202 NE STATE HIGHWAY 104 STE 105, KINGSTON, WA 98346-9454
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH60987430
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073032157
—
WA
05
—
1124105598
—
WA
05
—
1295287035
—
WA
05
—
1366890998
—
WA
Enumeration date
09/09/2019
Last updated
11/27/2023
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