Healthcare Provider Details

I. General information

NPI: 1871641514
Provider Name (Legal Business Name): WILLIAM JOSEPH COOKE DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST TUFTS UNIVSITY CRANIO-FACIAL PAIN CTR
BOSTON MA
02111-1527
US

IV. Provider business mailing address

1 KNEELAND ST TUFTS UNIVSITY CRANIO-FACIAL PAIN CTR
BOSTON MA
02111-1527
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6817
  • Fax:
Mailing address:
  • Phone: 617-636-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number529
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: