Provider Demographics
NPI:1912917782
Name:COOK, LOGAN C (DC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:C
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 1:1650 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1156
Mailing Address - Country:US
Mailing Address - Phone:847-781-0214
Mailing Address - Fax:847-781-0215
Practice Address - Street 1:1800 MCDONOUGH RD
Practice Address - Street 2:SUITE 160
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-4566
Practice Address - Country:US
Practice Address - Phone:847-742-7500
Practice Address - Fax:847-742-7502
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL045-82025OtherBLUE CROSS BLUE SHIELD
IL045-82025OtherBLUE CROSS BLUE SHIELD