=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386816023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC ASSOCIATE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2008
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22645 STATE HIGHWAY 59
-----------------------------------------------------
City | ROBERTSDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36567-3393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-947-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22645 STATE HIGHWAY 59
-----------------------------------------------------
City | ROBERTSDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36567-3393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-947-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. DOUGLAS KEITH COOPER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 251-947-4111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0035
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------