Healthcare Provider Details

I. General information

NPI: 1750490587
Provider Name (Legal Business Name): COX CHIROPRACTIC AND THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 SOUTH PARK AVE
BLASDELL NY
14219
US

IV. Provider business mailing address

3720 SOUTH PARK AVE
BLASDELL NY
14219
US

V. Phone/Fax

Practice location:
  • Phone: 716-826-2766
  • Fax: 716-825-3645
Mailing address:
  • Phone: 716-826-2766
  • Fax: 716-825-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008802
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011513
License Number StateNY

VIII. Authorized Official

Name: BRIAN M. COX
Title or Position: OWNER
Credential:
Phone: 716-826-2766