Provider Demographics
NPI:1154483311
Name:COOK, BRENDAN C (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:C
Last Name:COOK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 SAPLING CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6192
Mailing Address - Country:US
Mailing Address - Phone:631-836-1762
Mailing Address - Fax:
Practice Address - Street 1:219 RACINE DR
Practice Address - Street 2:SUITE C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8827
Practice Address - Country:US
Practice Address - Phone:910-367-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002950171100000X
NC600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist