Provider Demographics
NPI:1003241068
Name:COOPER, TIMOTHY STERLING (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:STERLING
Last Name:COOPER
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 1:2480 BROWNCROFT BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1435
Mailing Address - Country:US
Mailing Address - Phone:585-503-9059
Mailing Address - Fax:585-512-8741
Practice Address - Street 1:2480 BROWNCROFT BLVD STE 118
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-503-9059
Practice Address - Fax:585-512-8741
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012352-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300494296OtherMEDICARE