Provider Demographics
NPI:1619168929
Name:COOPER WELLNESS CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:COOPER WELLNESS CHIROPRACTIC CENTER INC
Other - Org Name:COOPER CHIROPRACTIC WELLNESS CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-447-3540
Mailing Address - Street 1:12217 SANTA MONICA BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2581
Mailing Address - Country:US
Mailing Address - Phone:310-447-3540
Mailing Address - Fax:310-447-3542
Practice Address - Street 1:12217 SANTA MONICA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2589
Practice Address - Country:US
Practice Address - Phone:310-447-3540
Practice Address - Fax:310-447-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty