Provider Demographics
NPI:1659301059
Name:COOK, DOUGLAS B (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:COOK
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 2055
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-8055
Mailing Address - Country:US
Mailing Address - Phone:580-774-2214
Mailing Address - Fax:580-774-2843
Practice Address - Street 1:1108 N. WASHINGTON
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096
Practice Address - Country:US
Practice Address - Phone:580-774-2214
Practice Address - Fax:580-774-2843
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
731338194OtherCIGNA
731338194OtherPPO OK
OKT75297Medicare UPIN
731338194OtherCIGNA
OK73-1338194Medicare PIN