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General NPI Number Information
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NPI Number | 1689606436
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Entity Type | Individual
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Provider Name | CHARITA NICOLE COOPER DC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 16705 SQUARE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-8722
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Country | US
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Telephone | 937-642-4400
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Fax | 937-642-4443
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Provider Business Mailing Address
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Address Line | 16705 SQUARE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-8476
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Country | US
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Telephone | 937-642-4400
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Fax | 937-642-4443
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3186
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License Number State | OH
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