Provider Demographics
NPI:1083769699
Name:COOK, MELISSA RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RUTH
Last Name:COOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6523
Mailing Address - Country:US
Mailing Address - Phone:612-385-8000
Mailing Address - Fax:715-423-5086
Practice Address - Street 1:410 DALY AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4744
Practice Address - Country:US
Practice Address - Phone:715-423-5050
Practice Address - Fax:715-423-5086
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4195-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI389668800Medicaid
WI00013585Medicare ID - Type Unspecified