Provider Demographics
NPI:1336218874
Name:COOPER, KENNETH CHARLES (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:COOPER
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Gender:M
Credentials:DC, PT
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Mailing Address - Street 1:2520 HARWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6709
Mailing Address - Country:US
Mailing Address - Phone:817-267-6222
Mailing Address - Fax:817-545-3488
Practice Address - Street 1:2520 HARWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6709
Practice Address - Country:US
Practice Address - Phone:817-267-6222
Practice Address - Fax:817-545-3488
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX5246111N00000X
TX1029361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist