1144486705 NPI number — COOPER FAMILY CHIROPRACTIC

Table of content: (NPI 1144486705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144486705 NPI number — COOPER FAMILY CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPER FAMILY CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144486705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9103 PHOENIX VILLAGE PKWY
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63368-4279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-265-2566
Provider Business Mailing Address Fax Number:
866-418-4148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9103 PHOENIX VILLAGE PKWY
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63368-4279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-265-2566
Provider Business Practice Location Address Fax Number:
866-418-4148
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-379-9105

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2000144756 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38309 . This is a "GHP/CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 432179 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7997538 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 139154 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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