=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922124288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHIL COOK DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 02/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 E CENTERVILLE RD
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75041-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-864-0999
-----------------------------------------------------
Fax | 972-840-8059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 E CENTERVILLE RD
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75041-4632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-864-0999
-----------------------------------------------------
Fax | 972-840-8059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PHILIP L COOK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 972-864-0999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC4072
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------