Provider Demographics
NPI:1720096373
Name:COOK, CRAIG (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
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 1:1465 ENCINITAS BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2951
Mailing Address - Country:US
Mailing Address - Phone:760-632-5445
Mailing Address - Fax:760-632-5499
Practice Address - Street 1:1465 ENCINITAS BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2951
Practice Address - Country:US
Practice Address - Phone:760-632-5445
Practice Address - Fax:760-632-5499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20146111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18284Medicare UPIN