Provider Demographics
NPI:1518914589
Name:COOK, WILLIAM STACEY (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STACEY
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 1:4099 WINTER DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1395
Mailing Address - Country:US
Mailing Address - Phone:248-321-0694
Mailing Address - Fax:
Practice Address - Street 1:51540 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-4446
Practice Address - Country:US
Practice Address - Phone:586-731-7730
Practice Address - Fax:586-731-1970
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWC004717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1877247Medicaid
T33173Medicare UPIN
MIOE06490Medicare ID - Type Unspecified