Provider Demographics
NPI:1861614596
Name:COOPER, TERRI LYN (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LYN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 E POST RD SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2016
Mailing Address - Country:US
Mailing Address - Phone:319-365-1141
Mailing Address - Fax:319-365-1146
Practice Address - Street 1:693 MARION BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3125
Practice Address - Country:US
Practice Address - Phone:319-365-1141
Practice Address - Fax:319-365-1146
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5590111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU36860Other1