MEDICARE: DR. RUSSELL J COX D.C.

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	A5684	IA
2	111N00000X	Chiropractor	A05684	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IB1972001	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	42464	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1063426476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL J COX D.C.

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	:	SUITE 3
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	06/06/2011

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