Provider Demographics
NPI:1841475597
Name:COOPER CHIROPRACTIC CARE, PC
Entity type:Organization
Organization Name:COOPER CHIROPRACTIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-282-5800
Mailing Address - Street 1:711 E MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7139
Mailing Address - Country:US
Mailing Address - Phone:541-282-5800
Mailing Address - Fax:541-282-7815
Practice Address - Street 1:711 E MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7139
Practice Address - Country:US
Practice Address - Phone:541-282-5800
Practice Address - Fax:541-282-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR244248Medicaid
OR244248Medicaid