Provider Demographics
NPI:1023586047
Name:COOPER, DANA ANTHONY JR (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ANTHONY
Last Name:COOPER
Suffix:JR
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 1:141 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4329
Mailing Address - Country:US
Mailing Address - Phone:386-225-6075
Mailing Address - Fax:
Practice Address - Street 1:141 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4329
Practice Address - Country:US
Practice Address - Phone:386-225-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4990111N00000X
FLCH13566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor