MEDICARE: COX CHIROPRACTIC CLINIC PLC

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
1	111N00000X	Chiropractor	A05684	IA

General Provider Information

NPI Number	:	1073813226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COX CHIROPRACTIC CLINIC PLC

Provider Business Mailing Address
First Line	:	520 S. GRAND AVE.
Second Line	:
City	:	MT. PLEASANT
State	:	IA
Zip	:	52641-1834
Country	:	US
Telephone Number	:	319-385-1430
Fax Number	:	319-385-1431

Provider Business Practice Location Address
First Line	:	520 S. GRAND AVE.
Second Line	:
City	:	MT. PLEASANT
State	:	IA
Zip	:	52641-1834
Country	:	US
Telephone Number	:	319-385-1430
Fax Number	:	319-385-1431

Authorized Official
Title or Position	:	OWNER - DR
Name	:	DR. RUSSELL JAME COX
Credential	:	D.C.
Telephone Number	:	319-385-1430

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	01/10/2012

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