Provider Demographics
NPI:1023031705
Name:COOK, JASON E (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:COOK
Suffix:
Gender:M
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:PO BOX 938
Mailing Address - Street 2:12 W COMMERCIAL STE A
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-0938
Mailing Address - Country:US
Mailing Address - Phone:918-543-3020
Mailing Address - Fax:918-543-2149
Practice Address - Street 1:12 W COMMERCIAL STE A
Practice Address - Street 2:
Practice Address - City:INOLA
Practice Address - State:OK
Practice Address - Zip Code:74036-0938
Practice Address - Country:US
Practice Address - Phone:918-543-3020
Practice Address - Fax:918-543-2149
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243730601Medicare PIN
300522353Medicare PIN
OKOK700704Medicare PIN
OKOKB5131Medicare PIN