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General NPI Number Information
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NPI Number | 1902052624
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Entity Type | Organization
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Legal Business Name | COOK CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 524 SPARTA RD
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1376
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Country | US
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Telephone | 478-552-2161
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Fax | 478-552-3007
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Provider Business Mailing Address
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Address Line | PO BOX 433
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City | TENNILLE
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State | GA
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Zip | 31089-0433
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Country | US
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Telephone | 478-552-2161
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Fax | 478-552-3007
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT DENNIS COOK
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Credential | D.C.
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Telephone | 478-552-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 002445
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License Number State | GA
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