Provider Demographics
NPI:1699707323
Name:COOLEY, KENT R (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:R
Last Name:COOLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6605 PRECINCT LINE RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-4374
Mailing Address - Country:US
Mailing Address - Phone:817-281-1995
Mailing Address - Fax:817-281-2174
Practice Address - Street 1:6605 PRECINCT LINE RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4374
Practice Address - Country:US
Practice Address - Phone:817-281-1995
Practice Address - Fax:817-281-2174
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017634-01Medicaid
TXU49214Medicare UPIN
TX605009Medicare ID - Type Unspecified