Provider Demographics
NPI:1689628562
Name:COOK, GREGORY B (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
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 1:61 POLARIS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5606
Mailing Address - Country:US
Mailing Address - Phone:815-356-6200
Mailing Address - Fax:224-509-8068
Practice Address - Street 1:61 POLARIS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5606
Practice Address - Country:US
Practice Address - Phone:815-356-6200
Practice Address - Fax:224-509-8068
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor