Healthcare Provider Details

I. General information

NPI: 1932600319
Provider Name (Legal Business Name): DBA COOPER FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 BROWNCROFT BLVD STE 118
ROCHESTER NY
14625-1435
US

IV. Provider business mailing address

2480 BROWNCROFT BLVD STE 118
ROCHESTER NY
14625-1435
US

V. Phone/Fax

Practice location:
  • Phone: 585-503-9059
  • Fax:
Mailing address:
  • Phone: 585-503-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number012352
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY COOPER
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 585-503-9059