Healthcare Provider Details

I. General information

NPI: 1447604186
Provider Name (Legal Business Name): COOPER WELLNESS AND CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W 44TH ST 8TH FLOOR
NEW YORK NY
10036-6611
US

IV. Provider business mailing address

15 W 44TH ST 8TH FLOOR
NEW YORK NY
10036-6611
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-5061
  • Fax: 646-941-5043
Mailing address:
  • Phone: 646-941-5061
  • Fax: 646-941-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010898
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004751
License Number StateNY

VIII. Authorized Official

Name: DR. BRANDON REID COOPER
Title or Position: OWNER
Credential: DC, LAC
Phone: 646-941-5061