Provider Demographics
NPI:1164481388
Name:MOOK, DOUGLAS L (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:MOOK
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 1:10700 SE 208TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5545
Mailing Address - Country:US
Mailing Address - Phone:253-854-3185
Mailing Address - Fax:253-852-9210
Practice Address - Street 1:10700 SE 208TH ST
Practice Address - Street 2:#207
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5545
Practice Address - Country:US
Practice Address - Phone:253-854-3185
Practice Address - Fax:253-852-9210
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB38016Medicare ID - Type Unspecified
WAAB38016Medicare PIN