Provider Demographics
NPI:1679656060
Name:SELBY- COOK, ERICA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LYNN
Last Name:SELBY- COOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:32500 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1991
Mailing Address - Country:US
Mailing Address - Phone:586-725-3100
Mailing Address - Fax:586-725-3155
Practice Address - Street 1:57911 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-2763
Practice Address - Country:US
Practice Address - Phone:586-228-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M35060Medicare PIN