Provider Demographics
NPI:1073219333
Name:COOK, KEVIN D (LMT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:COOK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1330
Mailing Address - Country:US
Mailing Address - Phone:716-367-7460
Mailing Address - Fax:
Practice Address - Street 1:4269 ST FRANCIS DR
Practice Address - Street 2:LOCATED IN BUKATY FAMILY CHIROPRACTIC
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1724
Practice Address - Country:US
Practice Address - Phone:716-422-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist