Healthcare Provider Details

I. General information

NPI: 1598743262
Provider Name (Legal Business Name): SCOTT B COOPER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 W MAIN ST STE E
MEDFORD OR
97501-2393
US

IV. Provider business mailing address

2390 W MAIN ST STE E
MEDFORD OR
97501-2393
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-5800
  • Fax: 541-282-7815
Mailing address:
  • Phone: 541-282-5800
  • Fax: 541-282-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3425
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: