Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4454 | KY |
NPI | 1629121868 |
---|---|
Provider Name | Dr. Roderick D Coxon |
First Address | Lebanon, KY 40033-1821 |
Second Address | Lebanon, KY 40033-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85000297 | (05) | KY |
U73807 | (02) | KY |