MEDICARE: CHRISTINE ANN COOK DC

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	27 2674	OR
2	111N00000X	Chiropractor	XOO6262	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	272674	OTHER	OR	LICENSE
2	XOO6262	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1427278068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ANN COOK DC

Provider Business Mailing Address
First Line	:	1532 MARYLHURST DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-1831
Country	:	US
Telephone Number	:	503-750-9865
Fax Number	:	503-635-4337

Provider Business Practice Location Address
First Line	:	15880 QUARRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3336
Country	:	US
Telephone Number	:	503-635-6451
Fax Number	:	503-635-4337

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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Directions to “ CHRISTINE ANN COOK DC” Practice Location

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