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General NPI Number Information
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NPI Number | 1912449323
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Entity Type | Organization
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Legal Business Name | DR KEN COOPER'S COOPERSTOWN CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 680 LANGSDORF DR STE 180
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City | FULLERTON
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State | CA
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Zip | 92831-3702
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Country | US
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Telephone | 714-525-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 15520 ROCKFIELD BLVD STE A200
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City | IRVINE
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State | CA
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Zip | 92618-6705
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Country | US
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Telephone | 949-598-9999
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Fax | 949-598-9990
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | KENNETH COOPER
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Credential | DC
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Telephone | 714-525-8700
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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 | DC21278
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License Number State | CA
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