Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC22312 | CA |
NPI | 1003945957 |
---|---|
Provider Name | Dr. Kevin William Cooper |
First Address | Placerville, CA 95667 |
Second Address | Placerville, CA 95667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |