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General NPI Number Information
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NPI Number | 1932600319
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Entity Type | Organization
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Legal Business Name | DBA COOPER FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 2480 BROWNCROFT BLVD STE 118
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City | ROCHESTER
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State | NY
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Zip | 14625-1435
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Country | US
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Telephone | 585-503-9059
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 BROWNCROFT BLVD STE 118
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City | ROCHESTER
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State | NY
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Zip | 14625-1435
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Country | US
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Telephone | 585-503-9059
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. TIMOTHY COOPER
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Credential | DC
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Telephone | 585-503-9059
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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 | 012352
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License Number State |
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