Provider Demographics
NPI:1043546211
Name:COOKSEY, JONATHAN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RYAN
Last Name:COOKSEY
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 1:203 WEGMAN RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9383
Mailing Address - Country:US
Mailing Address - Phone:662-415-1729
Mailing Address - Fax:662-286-4344
Practice Address - Street 1:3334 N POLK ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7223
Practice Address - Country:US
Practice Address - Phone:662-286-9950
Practice Address - Fax:662-286-4344
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor