Provider Demographics
NPI:1306832035
Name:COOK, GARRY L (DC)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:L
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 1:1001 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2511
Mailing Address - Country:US
Mailing Address - Phone:256-259-1707
Mailing Address - Fax:256-259-3842
Practice Address - Street 1:1001 S BROAD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2511
Practice Address - Country:US
Practice Address - Phone:256-259-1707
Practice Address - Fax:256-259-3842
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AL0788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor