Individual
DR. CHARLES R COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D. C.
Contact information
Practice address
108 CREEK LN S, JORDAN, MN 55352-1202
(952) 492-6363
(952) 492-5129
Mailing address
108 CREEK LN S, JORDAN, MN 55352-1202
(952) 492-6363
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
3717
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35719800
—
MN
05
—
460717100
—
MN
01
—
73D29CH
BCBS OFFICE ID
MN
01
—
73D30CO
BCBS PERSONAL ID
MN
Enumeration date
03/24/2006
Last updated
07/28/2010
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