MEDICARE: DR. DOUGLAS L MOOK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00034233	WA

General Provider Information

NPI Number	:	1164481388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS L MOOK DC

Provider Business Mailing Address
First Line	:	10700 SE 208TH ST STE 207
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-5545
Country	:	US
Telephone Number	:	253-854-3185
Fax Number	:	253-852-9210

Provider Business Practice Location Address
First Line	:	10700 SE 208TH ST
Second Line	:	#207
City	:	KENT
State	:	WA
Zip	:	98031-5545
Country	:	US
Telephone Number	:	253-854-3185
Fax Number	:	253-852-9210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/24/2007

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Directions to “ DR. DOUGLAS L MOOK DC” Practice Location

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