Provider Demographics
NPI:1023218682
Name:COOPER & COOPER, P.S.C.
Entity Type:Organization
Organization Name:COOPER & COOPER, P.S.C.
Other - Org Name:FIRST CHOICE CHIROPRACTIC P.S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-679-1166
Mailing Address - Street 1:PO BOX 3334
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3334
Mailing Address - Country:US
Mailing Address - Phone:606-679-1166
Mailing Address - Fax:606-679-1167
Practice Address - Street 1:106 LAKE AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2086
Practice Address - Country:US
Practice Address - Phone:425-235-9901
Practice Address - Fax:425-235-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8867005Medicare PIN