Provider Demographics
NPI:1194786889
Name:COOK, SCOTT R (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
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 1:266 S SEVENTH ST STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-465-9160
Mailing Address - Fax:724-465-9161
Practice Address - Street 1:266 S SEVENTH ST STE B
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-465-9160
Practice Address - Fax:724-465-9161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007584L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017811820002Medicaid
PA121705OtherHIGHMARK
PA034427Medicare ID - Type Unspecified
U78323Medicare UPIN