Provider Demographics
NPI:1164748422
Name:COOKE, BRIAN FLETCHER
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:FLETCHER
Last Name:COOKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 OTRANTO RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9603
Mailing Address - Country:US
Mailing Address - Phone:843-225-2550
Mailing Address - Fax:843-225-2590
Practice Address - Street 1:2294 OTRANTO RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9603
Practice Address - Country:US
Practice Address - Phone:843-225-2550
Practice Address - Fax:843-225-2590
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1811267925OtherGROUP NPI