Provider Demographics
NPI:1316277502
Name:COOK CHIROPRACTIC
Entity type:Organization
Organization Name:COOK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LONA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-720-8500
Mailing Address - Street 1:2029 COUNTY HIGHWAY I
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-4419
Mailing Address - Country:US
Mailing Address - Phone:715-720-8500
Mailing Address - Fax:715-720-8507
Practice Address - Street 1:2029 COUNTY HIGHWAY I
Practice Address - Street 2:SUITE 3
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-4419
Practice Address - Country:US
Practice Address - Phone:715-720-8500
Practice Address - Fax:715-720-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4578-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty