Provider Demographics
NPI:1538118229
Name:COOPER, ALAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
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 1:2645 ERIE DR
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-3203
Mailing Address - Country:US
Mailing Address - Phone:315-834-9614
Mailing Address - Fax:315-834-9985
Practice Address - Street 1:2645 ERIE DR
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-3203
Practice Address - Country:US
Practice Address - Phone:315-834-9614
Practice Address - Fax:315-834-9985
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000023032OtherBLUE CROSS BLUE SHIELD
NYC08005-3OtherWORKER'S COMP
NYC08005-3OtherWORKER'S COMP
NYT34969Medicare UPIN