Provider Demographics
NPI:1548385164
Name:COOLEY, PHILIP E (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:COOLEY
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:PO BOX 3362
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-3362
Mailing Address - Country:US
Mailing Address - Phone:540-731-3842
Mailing Address - Fax:540-731-9452
Practice Address - Street 1:601 3RD ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1409
Practice Address - Country:US
Practice Address - Phone:540-731-3842
Practice Address - Fax:540-731-9452
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA70285OtherSOUTHERN HEALTH
VA260392OtherANTHEM
VA47382OtherAMERICAN WHOLE HEALTH
VA5514171OtherAETNA
VA9411551Medicaid
VA9411551Medicaid