Provider Demographics
NPI:1174660237
Name:COOPER, LAURA KELLY (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KELLY
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KELLY
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4201 S A ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6049
Mailing Address - Country:US
Mailing Address - Phone:765-965-9500
Mailing Address - Fax:765-965-0432
Practice Address - Street 1:4201 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6049
Practice Address - Country:US
Practice Address - Phone:765-965-9500
Practice Address - Fax:765-965-0432
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002028A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300070238Medicaid
IN200468130AMedicaid