Provider Demographics
NPI:1104975721
Name:COOPER, CAROL ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5559
Mailing Address - Country:US
Mailing Address - Phone:503-393-6071
Mailing Address - Fax:503-390-5200
Practice Address - Street 1:4131 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5559
Practice Address - Country:US
Practice Address - Phone:503-393-6071
Practice Address - Fax:503-390-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2510111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGFKZMedicare PIN