Provider Demographics
NPI:1861614604
Name:COOK CHIROPRACTIC INCORPORATED
Entity type:Organization
Organization Name:COOK CHIROPRACTIC INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-548-8611
Mailing Address - Street 1:4112 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2928
Mailing Address - Country:US
Mailing Address - Phone:719-548-8611
Mailing Address - Fax:719-548-8612
Practice Address - Street 1:4112 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2928
Practice Address - Country:US
Practice Address - Phone:719-548-8611
Practice Address - Fax:719-548-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1114091972OtherNPI NUMBER FOR DOCTOR
COCO668324OtherBCBS GROUP NUMBER
CO1114091972OtherNPI NUMBER FOR DOCTOR
COC515198Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER