Provider Demographics
NPI:1114059227
Name:J COX ENTERPRISES LTD
Entity Type:Organization
Organization Name:J COX ENTERPRISES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEDIDIAH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-283-2230
Mailing Address - Street 1:825 NEW YORK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1044
Mailing Address - Country:US
Mailing Address - Phone:618-283-2230
Mailing Address - Fax:
Practice Address - Street 1:825 NEW YORK DR STE 1
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1044
Practice Address - Country:US
Practice Address - Phone:618-283-2230
Practice Address - Fax:618-283-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00332012OtherBCBS
IL793482OtherHEALTHLINK
IL038010423Medicaid
IL038010423Medicaid
ILK35842Medicare PIN
IL00332012OtherBCBS