Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 012494 | NY |
N | 111NS0005X | Chiropractic Sports Physician | 012494 | NY |
NPI | 1295159812 |
---|---|
Provider Name | Robert Cox |
First Address | Scottsdale, AZ 85255-6087 |
Second Address | Scottsdale, AZ 85255-6087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012494 | NEW YORK STATE LICENSE NUMBER (01) | NY |
8735 | CHIROPRACTIC LICENSE (01) | AZ |