Provider Demographics
NPI:1922163765
Name:COOK, NOAL A (DC)
Entity Type:Individual
Prefix:DR
First Name:NOAL
Middle Name:A
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 1:639 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU96157Medicare UPIN
WAAB38653Medicare ID - Type Unspecified