Provider Demographics
NPI:1861729865
Name:COOPER CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:COOPER CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KACI
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-433-0138
Mailing Address - Street 1:3004 SW 27TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3182
Mailing Address - Country:US
Mailing Address - Phone:806-372-3988
Mailing Address - Fax:806-372-1839
Practice Address - Street 1:3004 SW 27TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3182
Practice Address - Country:US
Practice Address - Phone:806-372-3988
Practice Address - Fax:806-372-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty