Provider Demographics
NPI:1609943752
Name:COOPER, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
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 1:10439 COMMERCE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7605
Mailing Address - Country:US
Mailing Address - Phone:317-872-9300
Mailing Address - Fax:317-872-9303
Practice Address - Street 1:10439 COMMERCE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7605
Practice Address - Country:US
Practice Address - Phone:317-872-9300
Practice Address - Fax:317-872-9303
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200025570Medicaid
IN000000092017OtherANTHEM
IN200025570Medicaid