Provider Demographics
NPI:1417085671
Name:COOK, LANCE P (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:P
Last Name:COOK
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 1:201 W PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-7173
Mailing Address - Country:US
Mailing Address - Phone:903-938-5454
Mailing Address - Fax:903-938-5488
Practice Address - Street 1:201 W PINECREST DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-7173
Practice Address - Country:US
Practice Address - Phone:903-938-5454
Practice Address - Fax:903-938-5488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605193Medicare ID - Type Unspecified