Provider Demographics
NPI:1699946855
Name:DR. LYLE KEITH COOPER
Entity type:Organization
Organization Name:DR. LYLE KEITH COOPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-968-2000
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-0899
Mailing Address - Country:US
Mailing Address - Phone:251-968-2000
Mailing Address - Fax:251-968-5953
Practice Address - Street 1:3325 GULF SHORES PARKWAY
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-968-2000
Practice Address - Fax:251-968-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-08-09
Deactivation Date:2008-08-13
Deactivation Code:
Reactivation Date:2011-08-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5841240001Medicare NSC