MEDICARE: DR. BRANDON REID COOPER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X010898	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407814817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON REID COOPER D.C.

Provider Business Mailing Address
First Line	:	450 PARK AVE S
Second Line	:	SUITE 2B
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-679-4233
Fax Number	:	212-679-4234

Provider Business Practice Location Address
First Line	:	450 PARK AVE S
Second Line	:	SUITE 2B
City	:	NEW YORK
State	:	NY
Zip	:	10016-7320
Country	:	US
Telephone Number	:	212-679-4233
Fax Number	:	212-679-4234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/22/2008

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