Provider Demographics
NPI:1598934598
Name:COOPER, DON S (DC)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:S
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 1:6 LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4224
Mailing Address - Country:US
Mailing Address - Phone:856-691-1313
Mailing Address - Fax:
Practice Address - Street 1:6 LASALLE ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4224
Practice Address - Country:US
Practice Address - Phone:856-691-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00163200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123871X72OtherMEDICARE PTAN
NJ123871X72OtherMEDICARE PTAN