Provider Demographics
NPI:1154536431
Name:COOPER, TERRI (DC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
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 1:211 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80759
Mailing Address - Country:US
Mailing Address - Phone:970-848-5388
Mailing Address - Fax:970-848-5388
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759-1915
Practice Address - Country:US
Practice Address - Phone:970-848-5388
Practice Address - Fax:970-848-5388
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC46423Medicare ID - Type Unspecified