Provider Demographics
NPI:1578527081
Name:POW, GARRY COOK (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:COOK
Last Name:POW
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 1:21400 S SALAMO RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7201
Mailing Address - Country:US
Mailing Address - Phone:503-650-2487
Mailing Address - Fax:503-650-4382
Practice Address - Street 1:21400 S SALAMO RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7201
Practice Address - Country:US
Practice Address - Phone:503-650-2487
Practice Address - Fax:503-650-4382
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003342111N00000X
OR27-3267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8349714Medicaid
WAGAB40205Medicare PIN
WA8349714Medicaid
U76316Medicare UPIN