Provider Demographics
NPI:1841476132
Name:COOL, MARCUS TYSON (DC)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:TYSON
Last Name:COOL
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 1:220 5TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2345
Mailing Address - Country:US
Mailing Address - Phone:541-926-0510
Mailing Address - Fax:541-926-5540
Practice Address - Street 1:220 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2345
Practice Address - Country:US
Practice Address - Phone:541-926-0510
Practice Address - Fax:541-926-5540
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor