Provider Demographics
NPI:1164601233
Name:DR COOPER ENTERPRISE
Entity Type:Organization
Organization Name:DR COOPER ENTERPRISE
Other - Org Name:CAROLINA CHIROPRACTIC AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:HARDIN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-548-8452
Mailing Address - Street 1:8763 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7589
Mailing Address - Country:US
Mailing Address - Phone:803-548-8452
Mailing Address - Fax:803-802-7732
Practice Address - Street 1:8763 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7589
Practice Address - Country:US
Practice Address - Phone:803-548-8452
Practice Address - Fax:803-802-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty