Healthcare Provider Details

I. General information

NPI: 1205226594
Provider Name (Legal Business Name): EDWARD ANTHONY COX IV D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BELLEVUE ST
GREEN BAY WI
54311-5605
US

IV. Provider business mailing address

429 MONROE ST
OCONTO WI
54153-1451
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-1963
  • Fax:
Mailing address:
  • Phone: 262-325-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5068-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: