Healthcare Provider Details

I. General information

NPI: 1750040978
Provider Name (Legal Business Name): ALEX BRIAN KOPEK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 ELEMENTARY WAY STE 119
OOLTEWAH TN
37363-3173
US

IV. Provider business mailing address

5945 ELEMENTARY WAY STE 119
OOLTEWAH TN
37363-3173
US

V. Phone/Fax

Practice location:
  • Phone: 423-225-2376
  • Fax:
Mailing address:
  • Phone: 423-225-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010674
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: