Provider Demographics
NPI:1821241787
Name:COOPER, KRISTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3488 SOLUTIONS CTR
Mailing Address - Street 2:#773488
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:630-468-1831
Mailing Address - Fax:630-468-1834
Practice Address - Street 1:3801 DYLAN PL
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1062
Practice Address - Country:US
Practice Address - Phone:859-296-2313
Practice Address - Fax:859-296-2399
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor