Provider Demographics
NPI:1093737066
Name:COOK CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:COOK CHIROPRACTIC CLINIC P.C.
Other - Org Name:COOK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-642-1913
Mailing Address - Street 1:103 9TH ST N
Mailing Address - Street 2:STE. 1
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4311
Mailing Address - Country:US
Mailing Address - Phone:701-642-1913
Mailing Address - Fax:701-642-1917
Practice Address - Street 1:103 9TH ST N
Practice Address - Street 2:STE. 1
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4311
Practice Address - Country:US
Practice Address - Phone:701-642-1913
Practice Address - Fax:701-642-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND70932Medicare ID - Type Unspecified