Provider Demographics
NPI:1063426476
Name:COX, RUSSELL J (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:COX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S. GRAND AVE.
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-1834
Mailing Address - Country:US
Mailing Address - Phone:319-385-1430
Mailing Address - Fax:319-385-1431
Practice Address - Street 1:520 S. GRAND AVE.
Practice Address - Street 2:SUITE 3
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1834
Practice Address - Country:US
Practice Address - Phone:319-385-1430
Practice Address - Fax:319-385-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5684111N00000X
IAA05684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IB1972001OtherMEDICARE PTAN
IA42464OtherBLUE CROSS BLUE SHIELD
IB1972001OtherMEDICARE PTAN
IA42464Medicare ID - Type Unspecified