Provider Demographics
NPI:1265492532
Name:COOLEY, JODI LUAINE (DC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LUAINE
Last Name:COOLEY
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 1:136 MILL ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3059
Mailing Address - Country:US
Mailing Address - Phone:614-472-0992
Mailing Address - Fax:614-472-0994
Practice Address - Street 1:136 MILL ST
Practice Address - Street 2:SUITE 120
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3059
Practice Address - Country:US
Practice Address - Phone:614-472-0992
Practice Address - Fax:614-472-0994
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167322Medicaid
OH0167322Medicaid
OH0788553Medicare PIN
OH0788552Medicare PIN