Provider Demographics
NPI:1831307669
Name:COOKE, MYRON BLAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:BLAINE
Last Name:COOKE
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 1:3756 SANTA ROSALIA DR STE 609
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-298-7956
Mailing Address - Fax:323-298-0971
Practice Address - Street 1:3756 SANTA ROSALIA DR STE 609
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-298-7956
Practice Address - Fax:323-298-0971
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18766111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18766OtherMEDICARE PTAN