Healthcare Provider Details

I. General information

NPI: 1619949203
Provider Name (Legal Business Name): JOANNA L COOK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA L COOK DC

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N PENN AVE
HARRISVILLE WV
26362
US

IV. Provider business mailing address

404 N PENN AVE
HARRISVILLE WV
26362-1128
US

V. Phone/Fax

Practice location:
  • Phone: 304-966-6344
  • Fax: 304-643-5152
Mailing address:
  • Phone: 304-966-6344
  • Fax: 304-643-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number826
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: