Provider Demographics
NPI:1720483100
Name:COOK, TRACEY (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E MARKET ST
Mailing Address - Street 2:STE B
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1845
Mailing Address - Country:US
Mailing Address - Phone:330-765-9811
Mailing Address - Fax:
Practice Address - Street 1:136 E MARKET ST
Practice Address - Street 2:STE B
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1845
Practice Address - Country:US
Practice Address - Phone:330-765-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14-1442175F00000X
OH65.000324171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath