Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X012352-1 | NY |
NPI | 1003241068 |
---|---|
Provider Name | Dr. Timothy Sterling Cooper |
First Address | Rochester, NY 14625-1435 |
Second Address | Rochester, NY 14625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
J300494296 | MEDICARE (01) | NY |