Provider Demographics
NPI:1013914860
Name:PROCOPIO, JOHN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:PROCOPIO
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 1:2625 45TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2902
Mailing Address - Country:US
Mailing Address - Phone:219-924-4457
Mailing Address - Fax:219-924-7301
Practice Address - Street 1:2617 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2902
Practice Address - Country:US
Practice Address - Phone:219-924-4457
Practice Address - Fax:219-924-7301
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001186A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90000629OtherBLUECROSSBLUESHIELD ID#
IN000000089157OtherANTHEM PROVIDER NUMBER
IN35-1865859OtherTAX ID
IN100148230AMedicaid
IN4667347OtherAETNA PROVIDER #
IN100148230AMedicaid
IN6511340001Medicare NSC
IN35-1865859OtherTAX ID
INU17869Medicare UPIN