Provider Demographics
NPI:1669639449
Name:COOPER CHIROPRACTIC AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:COOPER CHIROPRACTIC AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:646-941-5061
Mailing Address - Street 1:36 WEST 44TH STREET
Mailing Address - Street 2:SUITE 610 6FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8105
Mailing Address - Country:US
Mailing Address - Phone:646-941-5061
Mailing Address - Fax:646-941-5043
Practice Address - Street 1:36 WEST 44TH STREET
Practice Address - Street 2:SUITE 610 6FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8105
Practice Address - Country:US
Practice Address - Phone:646-941-5061
Practice Address - Fax:646-941-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty