Provider Demographics
NPI:1922271352
Name:BC CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BC CHIROPRACTIC CLINIC
Other - Org Name:COOPER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:GOODALL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:360-693-3030
Mailing Address - Street 1:4001 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1887
Mailing Address - Country:US
Mailing Address - Phone:360-693-3030
Mailing Address - Fax:360-828-1305
Practice Address - Street 1:4001 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1887
Practice Address - Country:US
Practice Address - Phone:360-693-3030
Practice Address - Fax:360-828-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty