Provider Demographics
NPI:1164514493
Name:COOK CHIROPRACTIC CENTER LTD.
Entity Type:Organization
Organization Name:COOK CHIROPRACTIC CENTER LTD.
Other - Org Name:HOROSHAK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOROSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-666-5104
Mailing Address - Street 1:19 E VERMILION DR
Mailing Address - Street 2:PO 395
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723
Mailing Address - Country:US
Mailing Address - Phone:218-666-5104
Mailing Address - Fax:218-749-1570
Practice Address - Street 1:19 E VERMILION DR
Practice Address - Street 2:PO 395
Practice Address - City:COOK
Practice Address - State:MN
Practice Address - Zip Code:55723
Practice Address - Country:US
Practice Address - Phone:218-666-5104
Practice Address - Fax:218-749-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
607585OtherMEDICA
63D99L0OtherBC
350047055OtherRR MEDICARE
U73693Medicare UPIN
350001848Medicare ID - Type Unspecified