Provider Demographics
NPI:1710032693
Name:COOKS, DAVID A (LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:COOKS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1301
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1301
Mailing Address - Country:US
Mailing Address - Phone:541-330-6606
Mailing Address - Fax:541-330-6612
Practice Address - Street 1:1569 SW NANCY WAY STE 5
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3234
Practice Address - Country:US
Practice Address - Phone:541-330-6606
Practice Address - Fax:541-330-6612
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist