Provider Demographics
NPI:1750429338
Name:COOPER, MATTHEW CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHRISTOPHER
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 1:2315 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8659
Mailing Address - Country:US
Mailing Address - Phone:636-978-6995
Mailing Address - Fax:
Practice Address - Street 1:2315 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8659
Practice Address - Country:US
Practice Address - Phone:636-978-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO38309OtherGHP-CMR
MO139372OtherBLUE CROSS BLUE SHEILD
MO441779OtherHEALTHLINK
MO4400068OtherUNITED HEALTHCARE