MEDICARE: PATRICK STEPHEN COOPER DC

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	3184	OH

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	:	1609801158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK STEPHEN COOPER DC

Provider Business Mailing Address
First Line	:	449 ALLENBY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-8722
Country	:	US
Telephone Number	:	937-642-4400
Fax Number	:	934-642-4443

Provider Business Practice Location Address
First Line	:	449 ALLENBY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-8722
Country	:	US
Telephone Number	:	937-642-4400
Fax Number	:	934-642-4443

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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Directions to “ PATRICK STEPHEN COOPER DC” Practice Location

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