Provider Demographics
NPI:1851662571
Name:COOPERSVILLE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:COOPERSVILLE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-218-1938
Mailing Address - Street 1:25 68TH AVE N
Mailing Address - Street 2:SUITE J
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9223
Mailing Address - Country:US
Mailing Address - Phone:616-997-1938
Mailing Address - Fax:
Practice Address - Street 1:25 68TH AVE N
Practice Address - Street 2:SUITE J
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-9223
Practice Address - Country:US
Practice Address - Phone:616-997-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty