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General NPI Number Information
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NPI Number | 1023215704
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Entity Type | Organization
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Legal Business Name | COOPER CHIROPRACTIC CORP.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 45 E 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-4302
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Country | US
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Telephone | 405-340-1930
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Fax | 405-340-5930
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Provider Business Mailing Address
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Address Line | 2909 MORGAN TRL
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City | EDMOND
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State | OK
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Zip | 73003-6662
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Country | US
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Telephone | 405-340-1930
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Fax | 405-340-5930
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRANDON COOPER
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Credential | D.C.
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Telephone | 405-340-1930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3792
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License Number State | OK
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