Provider Demographics
NPI:1891738878
Name:COOKE, JEFFREY MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
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 1:2520 MCVEY BLVD W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2830
Mailing Address - Country:US
Mailing Address - Phone:614-734-9858
Mailing Address - Fax:
Practice Address - Street 1:6827 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2517
Practice Address - Country:US
Practice Address - Phone:614-785-9455
Practice Address - Fax:614-785-9455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU58132Medicare UPIN
OH0645031Medicare PIN