NPIMap

Organization Active NPI

Active Life Chiropractic Clinic LLC

  • Sports Physician Chiropractor
  • Yakima, WA
National Provider Identifier
1174877955
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
CH60309681 Issued in WA
Legal business name
ACTIVE LIFE CHIROPRACTIC CLINIC LLC
Practice address
1015 S 40TH Ave Ste 21
Yakima, WA 98908-3868
Phone
(509) 965-9820
Fax
(509) 965-9822
NPI assigned
Nov 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kristina Lynn Coppock, D.C.NPI 1992059919
Title
Owner/Doctor/Office Manager
Phone
(509) 965-9820

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NP0017X CH60309681 WA
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X CH60309678 WA
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X CH60309681 WA Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X

Addresses

Primary practice location

1015 S 40TH Ave Ste 21
Yakima, WA 98908-3868

Mailing address

1015 S 40TH Ave Ste 21
Yakima, WA 98908-3868
Phone (509) 965-9820

Other names 1

  • Active Life Chiropractic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121213000492 WA Part B Supplier - Clinic/Group Practice 7810149135 Receives reassigned benefits from 2 practitioners
Practice locations: Yakima, WA

National Provider Directory

National Provider Directory

Locations

1015 S 40th Ave
Ste 21
Yakima, WA 98908
Phone (509) 965-9820

609 S 48th Ave
Yakima, WA 98908
Phone (509) 965-9820

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774915200000",
    "number": "1174877955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S 40TH AVE STE 21",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083868",
            "telephone_number": "509-965-9820",
            "fax_number": "509-965-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S 40TH AVE STE 21",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083868",
            "telephone_number": "509-965-9820",
            "fax_number": "509-965-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A",
        "authorized_official_last_name": "COPPOCK",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/DOCTOR/OFFICE MANAGER",
        "authorized_official_telephone_number": "509-965-9820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NP0017X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "WA",
            "license": "CH60309681",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "WA",
            "license": "CH60309678",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "WA",
            "license": "CH60309681",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Life Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.