Provider Demographics
NPI:1902962145
Name:COOPER, KEVIN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:COOPER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 PROVIDENCE HWY
Mailing Address - Street 2:STE 122
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2553
Mailing Address - Country:US
Mailing Address - Phone:508-921-3348
Mailing Address - Fax:508-921-3427
Practice Address - Street 1:1600 PROVIDENCE HWY
Practice Address - Street 2:STE 122
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2553
Practice Address - Country:US
Practice Address - Phone:508-921-3348
Practice Address - Fax:508-921-3427
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45241Medicare PIN
MA352614Medicare UPIN
MAY39412Medicare UPIN
MA351368Medicare UPIN