Provider Demographics
NPI:1952609695
Name:COOPER FAMILY & PEDIATRIC CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:COOPER FAMILY & PEDIATRIC CHIROPRACTIC P.C.
Other - Org Name:NANCY ELWARTOWSKI DC. PC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-853-6666
Mailing Address - Street 1:75 EXECUTIVE DR.
Mailing Address - Street 2:STE J
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-853-6666
Mailing Address - Fax:317-853-6666
Practice Address - Street 1:75 EXECUTIVE DR.
Practice Address - Street 2:STE J
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-853-6666
Practice Address - Fax:317-853-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200922000AMedicaid
IN313850Medicare PIN