MEDICARE: COX CHIROPRACTIC WELLNESS CENTER

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	261Q00000X	Clinic/Center	0104556792	VA

General Provider Information

NPI Number	:	1194015289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COX CHIROPRACTIC WELLNESS CENTER

Provider Business Mailing Address
First Line	:	801 POINDEXTER ST
Second Line	:	SUITE 219
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2358
Country	:	US
Telephone Number	:	757-304-0575
Fax Number	:	757-351-1930

Provider Business Practice Location Address
First Line	:	801 POINDEXTER ST
Second Line	:	SUITE 219
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2358
Country	:	US
Telephone Number	:	757-304-0575
Fax Number	:	757-351-1930

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHEENA MARIE COX
Credential	:	D.C.
Telephone Number	:	757-304-0575

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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