Provider Demographics
NPI:1104870559
Name:KOOK, HOWARD B (DC)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:B
Last Name:KOOK
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 1:1955 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3441
Mailing Address - Country:US
Mailing Address - Phone:973-762-2526
Mailing Address - Fax:973-762-1713
Practice Address - Street 1:1955 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3441
Practice Address - Country:US
Practice Address - Phone:973-762-2526
Practice Address - Fax:973-762-1713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8764603Medicaid
223530677OtherTAX ID
NJ454848Medicare UPIN