MEDICARE: DR. JOHN L PROCOPIO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08001186A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90000629	OTHER	IL	BLUECROSSBLUESHIELD ID#
2	000000089157	OTHER	IN	ANTHEM PROVIDER NUMBER
3	35-1865859	OTHER	IN	TAX ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4667347	OTHER	IN	AETNA PROVIDER #

General Provider Information

NPI Number	:	1013914860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN L PROCOPIO D.C.

Provider Business Mailing Address
First Line	:	2625 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2902
Country	:	US
Telephone Number	:	219-924-4457
Fax Number	:	219-924-7301

Provider Business Practice Location Address
First Line	:	2617 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2902
Country	:	US
Telephone Number	:	219-924-4457
Fax Number	:	219-924-7301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/25/2021

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