Provider Demographics
NPI:1447604186
Name:COOPER WELLNESS AND CHIROPRACTIC
Entity Type:Organization
Organization Name:COOPER WELLNESS AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:REID
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:646-941-5061
Mailing Address - Street 1:15 W 44TH ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6611
Mailing Address - Country:US
Mailing Address - Phone:646-941-5061
Mailing Address - Fax:646-941-5043
Practice Address - Street 1:15 W 44TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6611
Practice Address - Country:US
Practice Address - Phone:646-941-5061
Practice Address - Fax:646-941-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010898111N00000X
NY004751171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407814817OtherX7K46XBBK1