Provider Demographics
NPI:1902802309
Name:COOPER, KENNETH W (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:COOPER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 CAPITAL AVE SW
Mailing Address - Street 2:STE 4
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-5024
Mailing Address - Country:US
Mailing Address - Phone:269-274-5716
Mailing Address - Fax:
Practice Address - Street 1:4071 W DICKMAN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7551
Practice Address - Country:US
Practice Address - Phone:269-274-5716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-A3-1270-0OtherBCBSM PIN
MIOP23480Medicare ID - Type Unspecified
MI95-0-A3-1270-0OtherBCBSM PIN