Healthcare Provider Details

I. General information

NPI: 1043122120
Provider Name (Legal Business Name): KAYLYNN SYLVANA COOPER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E MAIN ST
VERSAILLES OH
45380-1517
US

IV. Provider business mailing address

27 E MAIN ST
VERSAILLES OH
45380-1517
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-3737
  • Fax: 844-890-2056
Mailing address:
  • Phone: 937-526-3737
  • Fax: 844-890-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number05572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: