Provider Demographics
NPI:1699719732
Name:COOPER, STEPHEN B (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
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:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36868-1611
Mailing Address - Country:US
Mailing Address - Phone:334-298-7700
Mailing Address - Fax:866-537-1711
Practice Address - Street 1:3700 S RAILROAD ST STE B
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2994
Practice Address - Country:US
Practice Address - Phone:334-298-7700
Practice Address - Fax:866-537-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004974111N00000X
AL1542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL114539Medicaid
GAU47094Medicare UPIN
AL114539Medicaid