=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427278068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE ANN COOK DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15880 QUARRY RD
-----------------------------------------------------
City | LAKE OSWEGO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97035-3336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-635-6451
-----------------------------------------------------
Fax | 503-635-4337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1532 MARYLHURST DR
-----------------------------------------------------
City | WEST LINN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97068-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-750-9865
-----------------------------------------------------
Fax | 503-635-4337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 27 2674
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | XOO6262
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------