Provider Demographics
NPI:1487615373
Name:COOPER, THOMAS STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEVEN
Last Name:COOPER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 CARSON CV
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4842
Mailing Address - Country:US
Mailing Address - Phone:501-336-8181
Mailing Address - Fax:501-336-8211
Practice Address - Street 1:965 CARSON CV
Practice Address - Street 2:SUITE A
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4842
Practice Address - Country:US
Practice Address - Phone:501-336-8181
Practice Address - Fax:501-336-8211
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU35410Medicare UPIN
AR59103Medicare ID - Type Unspecified