Provider Demographics
NPI:1306995774
Name:COOPER, AMAL F (D C)
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:F
Last Name:COOPER
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 DEVONPORT CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2609
Mailing Address - Country:US
Mailing Address - Phone:714-772-7100
Mailing Address - Fax:
Practice Address - Street 1:716 S STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4526
Practice Address - Country:US
Practice Address - Phone:714-772-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78393Medicare UPIN
CADC25680Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID