Provider Demographics
NPI:1962582353
Name:GREGORY B COOK PC
Entity type:Organization
Organization Name:GREGORY B COOK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-356-6200
Mailing Address - Street 1:61 POLARIS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5606
Mailing Address - Country:US
Mailing Address - Phone:815-356-6200
Mailing Address - Fax:224-509-8068
Practice Address - Street 1:61 POLARIS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5606
Practice Address - Country:US
Practice Address - Phone:815-356-6200
Practice Address - Fax:224-509-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty