Provider Demographics
NPI:1609942192
Name:COOPER, ROMAN B (DC)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:B
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 1:1106 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3305
Mailing Address - Country:US
Mailing Address - Phone:803-796-2424
Mailing Address - Fax:803-791-4076
Practice Address - Street 1:1106 12TH ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3305
Practice Address - Country:US
Practice Address - Phone:803-796-2424
Practice Address - Fax:803-791-4076
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU71063Medicare UPIN
SC8885Medicare PIN