Provider Demographics
NPI:1679665251
Name:KOOP, JAMES STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:KOOP
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 1:6851 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5420
Mailing Address - Country:US
Mailing Address - Phone:602-268-6000
Mailing Address - Fax:602-276-2600
Practice Address - Street 1:6851 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5420
Practice Address - Country:US
Practice Address - Phone:602-268-6000
Practice Address - Fax:602-276-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor