MEDICARE: COOL CHIROPRACTIC CLINIC INC.

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	2053	TX

General Provider Information

NPI Number	:	1447278239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOL CHIROPRACTIC CLINIC INC.

Provider Business Mailing Address
First Line	:	3315 E 47TH PL
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74135-2914
Country	:	US
Telephone Number	:	918-747-0011
Fax Number	:	918-747-0013

Provider Business Practice Location Address
First Line	:	3315 E 47TH PL
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74135-2914
Country	:	US
Telephone Number	:	918-747-0011
Fax Number	:	918-747-0013

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. TROY HOWARD COOL
Credential	:	D.C.
Telephone Number	:	918-747-0011

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/12/2014

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