Healthcare Provider Details

I. General information

NPI: 1861817140
Provider Name (Legal Business Name): MICHAEL COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 07/04/2021
Certification Date: 07/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14811 SAINT MARYS LN STE 155
HOUSTON TX
77079-2917
US

IV. Provider business mailing address

1770 SAINT JAMES PL STE 210
HOUSTON TX
77056-3432
US

V. Phone/Fax

Practice location:
  • Phone: 281-752-7388
  • Fax: 281-476-6134
Mailing address:
  • Phone: 713-622-3300
  • Fax: 281-476-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12273
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: