MEDICARE: DR. MARK COOPER ND

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	175F00000X	Naturopath	63	CO

General Provider Information

NPI Number	:	1518415884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK COOPER ND

Provider Business Mailing Address
First Line	:	1420 S 21ST ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4204
Country	:	US
Telephone Number	:	719-471-8411
Fax Number	:	719-471-8412

Provider Business Practice Location Address
First Line	:	1420 S 21ST ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-4204
Country	:	US
Telephone Number	:	719-471-8411
Fax Number	:	719-471-8412

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

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	09/15/2016

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Directions to “ DR. MARK COOPER ND” Practice Location

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