Healthcare Provider Details

I. General information

NPI: 1417883521
Provider Name (Legal Business Name): BRADLEY COOPER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S PLAZA DR STE 104
MENDOTA HEIGHTS MN
55120-1505
US

IV. Provider business mailing address

750 S PLAZA DR STE 104
MENDOTA HEIGHTS MN
55120-1505
US

V. Phone/Fax

Practice location:
  • Phone: 651-406-4454
  • Fax:
Mailing address:
  • Phone: 651-406-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7409
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: