Provider Demographics
NPI:1164553905
Name:HINTON, LAURA ANN COOKE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN COOKE
Last Name:HINTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 BONITA RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3249
Mailing Address - Country:US
Mailing Address - Phone:619-422-6900
Mailing Address - Fax:619-422-6903
Practice Address - Street 1:3450 BONITA RD STE 108
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3249
Practice Address - Country:US
Practice Address - Phone:619-422-6900
Practice Address - Fax:619-422-6903
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0260650Medicaid
CADC26065Medicare ID - Type Unspecified
CADC0260650Medicaid