Provider Demographics
NPI:1154470805
Name:COOK, GREGORY KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KEITH
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 1:2070 S INGALLS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2515
Mailing Address - Country:US
Mailing Address - Phone:303-909-0702
Mailing Address - Fax:
Practice Address - Street 1:950 17TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-2815
Practice Address - Country:US
Practice Address - Phone:303-292-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor