Healthcare Provider Details

I. General information

NPI: 1568657716
Provider Name (Legal Business Name): COOPER CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13159 EAST US HWY 27
BRANFORD FL
32008-0396
US

IV. Provider business mailing address

P.O. BOX 396
BRANFORD FL
32008-0396
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-1613
  • Fax: 386-935-3129
Mailing address:
  • Phone: 386-935-1613
  • Fax: 386-935-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH003975
License Number StateFL

VIII. Authorized Official

Name: DR. NANCY LEE COOPER
Title or Position: PRESIDENT
Credential: CHIROPRACTOR
Phone: 386-935-1613