Provider Demographics
NPI:1477697928
Name:COOPER, JULIE ANN
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1820
Mailing Address - Country:US
Mailing Address - Phone:970-874-5453
Mailing Address - Fax:970-874-5453
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1820
Practice Address - Country:US
Practice Address - Phone:970-874-5453
Practice Address - Fax:970-874-5453
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801943Medicare ID - Type Unspecified