MEDICARE: DR. KENNETH W 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	2301008406	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-0-A3-1270-0	OTHER	MI	BCBSM PIN

General Provider Information

NPI Number	:	1902802309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH W COOPER DC

Provider Business Mailing Address
First Line	:	693 CAPITAL AVE SW
Second Line	:	STE 4
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-5024
Country	:	US
Telephone Number	:	269-274-5716
Fax Number	:

Provider Business Practice Location Address
First Line	:	4071 W DICKMAN RD
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7551
Country	:	US
Telephone Number	:	269-274-5716
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/14/2016

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