Provider Demographics
NPI:1619078581
Name:COX, MICHAEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
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 1:441 W NORTH ST
Mailing Address - Street 2:P.O. BOX 5137
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-1005
Mailing Address - Country:US
Mailing Address - Phone:260-854-4942
Mailing Address - Fax:260-349-1320
Practice Address - Street 1:441 W NORTH ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1005
Practice Address - Country:US
Practice Address - Phone:260-854-4942
Practice Address - Fax:260-349-1320
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000714A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112490AMedicaid
IN224920Medicare PIN
INT34625Medicare UPIN