Provider Demographics
NPI:1992083802
Name:COPPINGER, JOHN CHRISTIAN (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:COPPINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CONCORD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3339
Mailing Address - Country:US
Mailing Address - Phone:865-440-8759
Mailing Address - Fax:
Practice Address - Street 1:601 S CONCORD ST STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3339
Practice Address - Country:US
Practice Address - Phone:856-440-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005898204D00000X
IN02003944A204D00000X
TN4078204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01678697OtherRR PTAN
IN201343910Medicaid
IN201343910Medicaid