Provider Demographics
NPI:1194960625
Name:COOLEY, RAYMOND J (DC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:COOLEY
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 1:71 ALLEN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-773-7700
Mailing Address - Fax:802-773-7720
Practice Address - Street 1:71 ALLEN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4570
Practice Address - Country:US
Practice Address - Phone:802-773-7700
Practice Address - Fax:802-773-7720
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000911701OtherMEDICARE PTAN
7652092OtherCIGNA