Provider Demographics
NPI:1629295902
Name:COOKE, DANIEL THOMAS (MSDC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:COOKE
Suffix:
Gender:F
Credentials:MSDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 ELMA G MILES PKWY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4021
Mailing Address - Country:US
Mailing Address - Phone:912-876-2225
Mailing Address - Fax:912-876-2158
Practice Address - Street 1:514 ELMA G MILES PKWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4021
Practice Address - Country:US
Practice Address - Phone:912-876-2225
Practice Address - Fax:912-876-2158
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA005299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor