MEDICARE: COOK CHIROPRACTIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	765	NM

General Provider Information

NPI Number	:	1043581150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOK CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	1017 W LUCK ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4334
Country	:	US
Telephone Number	:	575-388-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 HIGHWAY 180 W
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4400
Country	:	US
Telephone Number	:	575-388-3352
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MERRILL D COOK
Credential	:	D.C.
Telephone Number	:	575-388-3352

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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Directions to “COOK CHIROPRACTIC PA ” Practice Location

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