Cook, Charles R

Cook, Charles R is an sole proprietor health care provider with primary practice located at 108 Creek Ln S , Jordan MN 55352-1202. He recently has only one registered license in Chiropractic Providers / Sports Physician, which is considered as his primary health care specialty. Cook, Charles R can be contacted via phone (952) 492-6363.

Contact Information

Primary practice address
108 Creek Ln S Jordan MN 55352-1202
Phone: (952) 492-6363
Fax: (952) 492-5129
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Sports Physician 111NS0005X 3717 Minnesota

Profile Details

NPI number 1134189202
LBN Legal business name Cook, Charles R
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 24th, 2006
Last updated Jul 28th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134189202 NPPES
Minnesota MEDICAID 460717100
Minnesota Other 73D29CH
Minnesota MEDICAID 35719800
Minnesota Other 73D30CO

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