Healthcare Provider Details

I. General information

NPI: 1023031705
Provider Name (Legal Business Name): JASON E COOK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W COMMERCIAL STE A
INOLA OK
74036-0938
US

IV. Provider business mailing address

PO BOX 938 12 W COMMERCIAL STE A
INOLA OK
74036-0938
US

V. Phone/Fax

Practice location:
  • Phone: 918-543-3020
  • Fax: 918-543-2149
Mailing address:
  • Phone: 918-543-3020
  • Fax: 918-543-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3785
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: