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General NPI Number Information
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NPI Number | 1912121708
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Entity Type | Organization
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Legal Business Name | COOLEY CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 5722 HOMESTEAD RD
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City | DULUTH
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State | MN
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Zip | 55804
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Country | US
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Telephone | 218-525-3630
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Fax | 218-525-3914
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Provider Business Mailing Address
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Address Line | 5722 HOMESTEAD ROAD
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City | DULUTH
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State | MN
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Zip | 55804
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Country | US
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Telephone | 218-525-3630
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Fax | 218-525-3914
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC OWNER
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Name | MARY CLARE COOLEY
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Credential | DC
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Telephone | 218-525-3630
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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 | 2079
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License Number State | MN
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