Provider Demographics
NPI:1073803664
Name:MAYDA COX CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MAYDA COX CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-645-1177
Mailing Address - Street 1:1755 ORANGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3130
Mailing Address - Country:US
Mailing Address - Phone:949-645-1177
Mailing Address - Fax:949-548-0076
Practice Address - Street 1:1755 ORANGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3130
Practice Address - Country:US
Practice Address - Phone:949-645-1177
Practice Address - Fax:949-548-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23777302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WDC23777AMedicare UPIN