Provider Demographics
NPI:1790114791
Name:COOK CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:COOK CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-391-2472
Mailing Address - Street 1:639 SUNSET PARK DR
Mailing Address - Street 2:SUITE# 103
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1540
Mailing Address - Country:US
Mailing Address - Phone:360-856-6557
Mailing Address - Fax:360-856-2913
Practice Address - Street 1:639 SUNSET PARK DR
Practice Address - Street 2:SUITE# 103
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1540
Practice Address - Country:US
Practice Address - Phone:360-856-6557
Practice Address - Fax:360-856-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB38653Medicare UPIN