MEDICARE: MICHAEL COOPER

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	12273	TX

General Provider Information

NPI Number	:	1861817140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL COOPER

Provider Business Mailing Address
First Line	:	1770 SAINT JAMES PL
Second Line	:	STE 210
City	:	HOUSTON
State	:	TX
Zip	:	77056-3432
Country	:	US
Telephone Number	:	713-622-3300
Fax Number	:	281-476-6134

Provider Business Practice Location Address
First Line	:	14811 SAINT MARYS LN STE 155
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2917
Country	:	US
Telephone Number	:	281-752-7388
Fax Number	:	281-476-6134

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

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	07/04/2021

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Directions to “ MICHAEL COOPER ” Practice Location

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