Provider Demographics
NPI:1578997672
Name:COOPER, LAUREN NICHOLLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICHOLLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 W COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4269
Mailing Address - Country:US
Mailing Address - Phone:407-647-3244
Mailing Address - Fax:
Practice Address - Street 1:267 W COMSTOCK AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4269
Practice Address - Country:US
Practice Address - Phone:407-647-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor