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NPI Code Detail

MEDICARE: TIMOTHY COOK D.C., B.S.N

MEDICARE: TIMOTHY COOK D.C., B.S.N
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
1111N00000XChiropractor2377AL
2111N00000XChiropractorCHIR006726GA
3111N00000XChiropractorCH4879KY

General Provider Information

NPI Number : 1457553547
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY COOK D.C., B.S.N
Provider Business Mailing Address
First Line : 1400 N DUTTON AVE STE 13
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-7120
Country : US
Telephone Number : 707-526-2225
Fax Number :
Provider Business Practice Location Address
First Line : 1400 N DUTTON AVE STE 13
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-7120
Country : US
Telephone Number : 707-526-2225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 11/26/2018

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