Provider Demographics
NPI:1972750610
Name:COOK, J. KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:KENNETH
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 1:1050 BARBER CREEK DR BLDG 200
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4500
Mailing Address - Country:US
Mailing Address - Phone:706-548-8984
Mailing Address - Fax:706-383-7781
Practice Address - Street 1:1050 BARBER CREEK DR BLDG 200
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4500
Practice Address - Country:US
Practice Address - Phone:706-548-8984
Practice Address - Fax:706-383-7781
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I350212Medicare UPIN
GA511I350212Medicare UPIN