Healthcare Provider Details

I. General information

NPI: 1659134385
Provider Name (Legal Business Name): JENNA COOK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 SE MONTEREY RD
STUART FL
34994-4410
US

IV. Provider business mailing address

632 SE MONTEREY RD
STUART FL
34994-4410
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-3313
  • Fax:
Mailing address:
  • Phone: 772-219-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15735
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number289903
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: