Provider Demographics
NPI:1679111512
Name:COOPER, NATALIE DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:DANIELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 WHISTLING STRAITS DR APT 110
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2261
Mailing Address - Country:US
Mailing Address - Phone:651-472-2702
Mailing Address - Fax:
Practice Address - Street 1:3610 OAKWOOD MALL DR STE 103
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9084
Practice Address - Country:US
Practice Address - Phone:715-598-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5494-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor