Healthcare Provider Details

I. General information

NPI: 1992083802
Provider Name (Legal Business Name): JOHN CHRISTIAN COPPINGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S CONCORD ST STE 102
KNOXVILLE TN
37919-3339
US

IV. Provider business mailing address

601 S CONCORD ST STE 102
KNOXVILLE TN
37919-3339
US

V. Phone/Fax

Practice location:
  • Phone: 856-440-8759
  • Fax:
Mailing address:
  • Phone: 865-440-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34005898
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number02003944A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number4078
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: