Organization
COOPER CHIROPRACTIC AND NEUROLOGICAL DIAGNOSTIC CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANTON TUCKER COOPER D.C.,D.A.C.A.N. (PROVIDER)
(321) 726-8116
Entity
Organization
Contact information
Practice address
1501 ROBERT J CONLAN BLVD, SUITE 3, NE PALM BAY, FL 32905-3502
(321) 726-8116
(321) 725-8535
Mailing address
1501 ROBERT J CONLAN BLVD NE, SUITE 3, PALM BAY, FL 32905-3502
(321) 726-8116
(321) 725-8535
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH0003976
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88902
BLUE CROSS
FL
Enumeration date
03/28/2007
Last updated
10/24/2012
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