Provider Demographics
NPI:1720183288
Name:COOPER, TERRANCE MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:MARSHALL
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 1:313 WEST 200 SOUTH PO BOX 1865
Mailing Address - Street 2:
Mailing Address - City:PAROWAN
Mailing Address - State:UT
Mailing Address - Zip Code:84761
Mailing Address - Country:US
Mailing Address - Phone:435-477-1700
Mailing Address - Fax:435-477-9411
Practice Address - Street 1:313 WEST 200 SOUTH
Practice Address - Street 2:
Practice Address - City:PAROWAN
Practice Address - State:UT
Practice Address - Zip Code:84761
Practice Address - Country:US
Practice Address - Phone:435-477-1700
Practice Address - Fax:435-477-9144
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT125666-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870395551TCOOPMedicaid
UT00005637Medicare ID - Type UnspecifiedMEDICARE