Provider Demographics
NPI:1538375050
Name:COOPER, PAULETTE J (DC)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PALI
Other - Middle Name:J
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:300 TAMAL PLZ
Mailing Address - Street 2:100
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1129
Mailing Address - Country:US
Mailing Address - Phone:415-924-3381
Mailing Address - Fax:415-924-3380
Practice Address - Street 1:300 TAMAL PLZ
Practice Address - Street 2:100
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1129
Practice Address - Country:US
Practice Address - Phone:415-924-3381
Practice Address - Fax:415-924-3380
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0219280Medicare PIN