MEDICARE: SCOTT F COOK D.C.

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	5503	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	COB2396	OTHER	CO	BCBS PROVIDER NUMBER
2	CO668324	OTHER	CO	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1114091972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT F COOK D.C.

Provider Business Mailing Address
First Line	:	4112 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2928
Country	:	US
Telephone Number	:	719-548-8611
Fax Number	:	719-548-8612

Provider Business Practice Location Address
First Line	:	4112 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2928
Country	:	US
Telephone Number	:	719-548-8611
Fax Number	:	719-548-8612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/09/2007

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