Provider Demographics
NPI:1568542546
Name:COOPER, STANTON TUCKER (DC, DACAN)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:TUCKER
Last Name:COOPER
Suffix:
Gender:M
Credentials:DC, DACAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ROBERT J CONLAN BLVD NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3502
Mailing Address - Country:US
Mailing Address - Phone:321-726-8116
Mailing Address - Fax:321-726-8535
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3502
Practice Address - Country:US
Practice Address - Phone:321-726-8116
Practice Address - Fax:321-726-8535
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003926111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88902ZOtherMEDICARE