Provider Demographics
NPI:1982665931
Name:COOPER, VICTOR H (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:H
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:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-0265
Mailing Address - Country:US
Mailing Address - Phone:270-866-3543
Mailing Address - Fax:270-866-8371
Practice Address - Street 1:350 LAKEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-0265
Practice Address - Country:US
Practice Address - Phone:270-866-3543
Practice Address - Fax:270-866-8371
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3580R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85036366Medicaid
0006302Medicare ID - Type Unspecified
0006303Medicare ID - Type Unspecified
KY85036366Medicaid