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General NPI Number Information
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NPI Number | 1033152723
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Entity Type | Organization
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Legal Business Name | COOK CHIROPRACTIC CLINIC P C
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 51540 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-4446
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Country | US
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Telephone | 586-731-7730
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Fax | 586-731-1970
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Provider Business Mailing Address
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Address Line | 51540 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-4446
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Country | US
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Telephone | 586-731-7730
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Fax | 586-731-1970
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. WILLIAM STACEY COOK
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Credential | DC
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Telephone | 586-731-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | WC004717
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License Number State | MI
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