Provider Demographics
NPI:1609960673
Name:COHOON, TY JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:JACOB
Last Name:COHOON
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 1:3007 GARDEN GROVE PKWY
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-3907
Mailing Address - Country:US
Mailing Address - Phone:620-662-6160
Mailing Address - Fax:620-662-2820
Practice Address - Street 1:3007 GARDEN GROVE PKWY
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-3907
Practice Address - Country:US
Practice Address - Phone:620-662-6160
Practice Address - Fax:620-662-2820
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062107Medicare ID - Type UnspecifiedPROVIDER NUMBER