Provider Demographics
NPI:1619949203
Name:COOK, JOANNA L (DC)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:L
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:404 N PENN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-1128
Mailing Address - Country:US
Mailing Address - Phone:304-966-6344
Mailing Address - Fax:304-643-5152
Practice Address - Street 1:404 N PENN AVE
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362
Practice Address - Country:US
Practice Address - Phone:304-966-6344
Practice Address - Fax:304-643-5152
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006837Medicaid
WV001889916OtherBCBS
SCCH3046Medicaid
OH2699174Medicaid
SCCH3046Medicaid
WV4199011Medicare PIN