Provider Demographics
NPI:1407814817
Name:COOPER, BRANDON REID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:REID
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 1:450 PARK AVE S
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7320
Mailing Address - Country:US
Mailing Address - Phone:212-679-4233
Mailing Address - Fax:212-679-4234
Practice Address - Street 1:450 PARK AVE S
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7320
Practice Address - Country:US
Practice Address - Phone:212-679-4233
Practice Address - Fax:212-679-4234
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02623509Medicaid
NYX7K461Medicare ID - Type UnspecifiedPROVIDER
NY02623509Medicaid
NYXBWBK1Medicare ID - Type UnspecifiedGROUP