Active NPI
Mary Clare Cooley, DC
- Chiropractor
- Duluth, MN
National Provider Identifier
1003956533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2079
- Practice address
- 5722 Homestead Rd
Duluth, MN 55804-9661 - Phone
- (218) 525-3630
- Fax
- (218) 525-3630
- NPI assigned
- Feb 7, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2079 | MN | Primary |
Addresses
Primary practice location
5722 Homestead Rd
Duluth, MN 55804-9661
Mailing address
5722 Homestead Rd
Duluth, MN 55804-9661
Phone (218) 525-3630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 70913CO | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2079 | MN | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stout Chiropractic Care, SC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Medical Specialty Clinic/Center
- Two Harbors, MN
- NPI 1871623769
Chiropractor
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1003956533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5722 HOMESTEAD RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558049661",
"telephone_number": "218-525-3630",
"fax_number": "218-525-3914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5722 HOMESTEAD RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558049661",
"telephone_number": "218-525-3630",
"fax_number": "218-525-3630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOLEY",
"first_name": "MARY",
"middle_name": "CLARE",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "2079",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "70913CO",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.