Provider Demographics
NPI:1154643179
Name:COOLEY, JERALD F (DC)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:F
Last Name:COOLEY
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 1:602 E OHIO ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2356
Mailing Address - Country:US
Mailing Address - Phone:660-890-0700
Mailing Address - Fax:660-890-0705
Practice Address - Street 1:602 E OHIO ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2356
Practice Address - Country:US
Practice Address - Phone:660-890-0700
Practice Address - Fax:660-890-0705
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor