Provider Demographics
NPI:1225589138
Name:KOPET, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KOPET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18920 BOTHELL WAY NE
Mailing Address - Street 2:STE 100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1981
Mailing Address - Country:US
Mailing Address - Phone:425-327-1138
Mailing Address - Fax:
Practice Address - Street 1:18920 BOTHELL WAY NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1981
Practice Address - Country:US
Practice Address - Phone:425-486-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60701217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor