Provider Demographics
NPI:1932127529
Name:COOPER, MATTHEW I (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:I
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 1:21000 NE 28TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1421
Mailing Address - Country:US
Mailing Address - Phone:305-935-9599
Mailing Address - Fax:305-932-5612
Practice Address - Street 1:21000 NE 28TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1421
Practice Address - Country:US
Practice Address - Phone:305-935-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7801111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201298976OtherTAX ID
FLK6893Medicare ID - Type Unspecified