Provider Demographics
NPI:1902698822
Name:COOPER, RILEY (DC)
Entity type:Individual
Prefix:DR
First Name:RILEY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49577 BIG CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-7306
Mailing Address - Country:US
Mailing Address - Phone:660-822-1942
Mailing Address - Fax:
Practice Address - Street 1:230 5TH ST
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:MO
Practice Address - Zip Code:63456-1342
Practice Address - Country:US
Practice Address - Phone:660-822-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025036866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor