Provider Demographics
NPI:1023073301
Name:COOK, KAZUNORI 'SAM' (DC)
Entity type:Individual
Prefix:
First Name:KAZUNORI
Middle Name:'SAM'
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:PO BOX 64184
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-4184
Mailing Address - Country:US
Mailing Address - Phone:806-793-5770
Mailing Address - Fax:806-793-5771
Practice Address - Street 1:3601 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2833
Practice Address - Country:US
Practice Address - Phone:806-793-5770
Practice Address - Fax:806-793-5771
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9941OtherBLUE CROSS BLUE SHIELD
NM450932YYAHMedicare PIN
V08379Medicare UPIN
TX8G3763Medicare ID - Type Unspecified