Provider Demographics
NPI:1780644609
Name:COOPER, GREGORY STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEVEN
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 1:713 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3713
Mailing Address - Country:US
Mailing Address - Phone:843-821-8787
Mailing Address - Fax:843-821-8799
Practice Address - Street 1:713 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3713
Practice Address - Country:US
Practice Address - Phone:843-821-8787
Practice Address - Fax:843-821-8799
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT237395040Medicare ID - Type Unspecified