Provider Demographics
NPI:1528052917
Name:COOK, JAMES R (DC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
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 1:103 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4311
Mailing Address - Country:US
Mailing Address - Phone:701-642-1913
Mailing Address - Fax:701-642-1917
Practice Address - Street 1:103 9TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4311
Practice Address - Country:US
Practice Address - Phone:701-642-1913
Practice Address - Fax:701-642-1917
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13361Medicaid
4252Medicare ID - Type Unspecified
ND13361Medicaid