Provider Demographics
NPI:1609946193
Name:COPPOLA, JOHN V (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13150 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1961
Mailing Address - Country:US
Mailing Address - Phone:210-492-0111
Mailing Address - Fax:210-202-5122
Practice Address - Street 1:13150 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1961
Practice Address - Country:US
Practice Address - Phone:210-492-0111
Practice Address - Fax:210-202-5122
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU65759Medicare UPIN