Provider Demographics
NPI:1982647301
Name:COOK, PHILIP LYNN (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:LYNN
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 1:104 E CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-4632
Mailing Address - Country:US
Mailing Address - Phone:972-864-0999
Mailing Address - Fax:
Practice Address - Street 1:104 E CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4632
Practice Address - Country:US
Practice Address - Phone:972-864-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012866-01Medicaid
TXT12762Medicare UPIN
TX0012866-01Medicaid