Healthcare Provider Details

I. General information

NPI: 1902802309
Provider Name (Legal Business Name): KENNETH W COOPER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 W DICKMAN RD
SPRINGFIELD MI
49037-7551
US

IV. Provider business mailing address

693 CAPITAL AVE SW STE 4
BATTLE CREEK MI
49015-5024
US

V. Phone/Fax

Practice location:
  • Phone: 269-274-5716
  • Fax:
Mailing address:
  • Phone: 269-274-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: