Provider Demographics
NPI:1497963052
Name:COSPER, STEVEN B I (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:COSPER
Suffix:I
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 1:206 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2750
Mailing Address - Country:US
Mailing Address - Phone:706-882-3388
Mailing Address - Fax:706-882-3940
Practice Address - Street 1:206 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2750
Practice Address - Country:US
Practice Address - Phone:706-882-3388
Practice Address - Fax:706-882-3940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROO2504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor