Provider Demographics
NPI:1023215704
Name:COOPER CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:COOPER CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-340-1930
Mailing Address - Street 1:2909 MORGAN TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6662
Mailing Address - Country:US
Mailing Address - Phone:405-340-1930
Mailing Address - Fax:405-340-5930
Practice Address - Street 1:45 E 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4302
Practice Address - Country:US
Practice Address - Phone:405-340-1930
Practice Address - Fax:405-340-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
600522395Medicare PIN