Provider Demographics
NPI:1255439279
Name:COOK, CORISSA ANGIULLI (DC)
Entity type:Individual
Prefix:MRS
First Name:CORISSA
Middle Name:ANGIULLI
Last Name:COOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:CORISSA
Other - Middle Name:LEE
Other - Last Name:ANGIULLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2625 ROCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-779-0001
Mailing Address - Fax:724-779-0003
Practice Address - Street 1:2625 ROCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-779-0001
Practice Address - Fax:724-779-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-009683111N00000X
PADC009683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017656550002Medicaid
PA103854Medicare PIN