Provider Demographics
NPI:1427278068
Name:COOK, CHRISTINE ANN (DC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 MARYLHURST DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1831
Mailing Address - Country:US
Mailing Address - Phone:503-750-9865
Mailing Address - Fax:503-635-4337
Practice Address - Street 1:15880 QUARRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3336
Practice Address - Country:US
Practice Address - Phone:503-635-6451
Practice Address - Fax:503-635-4337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2674111N00000X
NYXOO6262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR272674OtherLICENSE
NYXOO6262OtherLICENSE
NYXOO6262OtherLICENSE