Provider Demographics
NPI:1508060047
Name:COOPER, ALISA JOY
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:JOY
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALISA
Other - Middle Name:JOY
Other - Last Name:WECHLSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, CCN
Mailing Address - Street 1:10710 N 140TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4618
Mailing Address - Country:US
Mailing Address - Phone:480-699-9735
Mailing Address - Fax:
Practice Address - Street 1:10710 N 140TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4618
Practice Address - Country:US
Practice Address - Phone:480-699-9735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6051111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition