Provider Demographics
NPI:1205874682
Name:COOPER, TODD A (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
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 1:396 TIM WARREN RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-8212
Mailing Address - Country:US
Mailing Address - Phone:423-878-3396
Mailing Address - Fax:
Practice Address - Street 1:911 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2105
Practice Address - Country:US
Practice Address - Phone:423-764-2663
Practice Address - Fax:423-793-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9403426Medicaid
TN9403426Medicaid
TNU-10292Medicare UPIN