Provider Demographics
NPI:1972176444
Name:COOK, MIKAH (DC)
Entity Type:Individual
Prefix:DR
First Name:MIKAH
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CAPISTRANO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-7218
Mailing Address - Country:US
Mailing Address - Phone:805-265-0880
Mailing Address - Fax:805-855-4778
Practice Address - Street 1:5805 CAPISTRANO AVE STE A
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7218
Practice Address - Country:US
Practice Address - Phone:805-265-0880
Practice Address - Fax:805-855-4778
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35080111NN1001X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition