Provider Demographics
NPI:1063913127
Name:HOPPER KOPPELMAN, MELANIE (DAC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HOPPER KOPPELMAN
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HARBOR INTEGRATIVE HEALTH, LLC
Mailing Address - Street 2:60 POPPASQUASH ROAD
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809
Mailing Address - Country:US
Mailing Address - Phone:401-366-2026
Mailing Address - Fax:
Practice Address - Street 1:HARBOR INTEGRATIVE HEALTH, LLC
Practice Address - Street 2:60 POPPASQUASH ROAD
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809
Practice Address - Country:US
Practice Address - Phone:401-366-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00478171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist