Kristina Lynn Coppock, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

CH60309681 Issued in WA

Practice address

609 S 48TH Ave
Yakima, WA 98908-3614

Phone

(509) 965-9820

Fax

(509) 965-9822

NPI assigned

Oct 29, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kristina Lynn Reisenauer Former name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Life Chiropractic Clinic LLCGroup PAC ID 7810149135, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Active Life Chiropractic Clinic LLC

  • Sports Physician Chiropractor
  • Yakima, WA
  • NPI 1174877955
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351468800000",
    "number": "1992059919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 S 48TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083614",
            "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": "609 S 48TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083614",
            "telephone_number": "509-965-9820",
            "fax_number": "509-965-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOCK",
        "first_name": "KRISTINA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WA",
            "license": "CH60309681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "REISENAUER",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert K Cooper, MD
• Amanda Copeland
• Charles R Copeland
• Seth T Copeland, OD
• Copper Creek Medical, Inc.
• Nathan Zane Coppock, D.C.
• Corazon de Chavela LLC
• Allie Corey
• Joanna Cornejo-Ortiz
• Mayra Laura Corona, CO61217554

• Sports Physician Chiropractor in Yakima, WA
• Providers in Yakima, WA by specialty
• Sports Physician Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.