Provider Demographics
NPI:1942303144
Name:COOPER, KARIS MARIE (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:KARIS
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034561111N00000X
OR71 3654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA206447OtherLABOR AND INDUSTRIES