Provider Demographics
NPI:1619960283
Name:LIGONIER CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:LIGONIER CHIROPRACTIC CENTER PC
Other - Org Name:GREGORY A COX DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:COX
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:260-894-7490
Mailing Address - Street 1:8018 W 1000 N
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-9797
Mailing Address - Country:US
Mailing Address - Phone:260-894-7490
Mailing Address - Fax:260-894-7455
Practice Address - Street 1:8018 W 1000 N
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-9797
Practice Address - Country:US
Practice Address - Phone:260-894-7490
Practice Address - Fax:260-894-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000918A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182548OtherANTHEM
IN581780Medicare PIN
IN000000182548OtherANTHEM