Provider Demographics
NPI:1629121868
Name:COXON, RODERICK D (DC)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:D
Last Name:COXON
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 1:112 LEBANON TRADE CTR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1821
Mailing Address - Country:US
Mailing Address - Phone:270-699-2323
Mailing Address - Fax:270-699-2323
Practice Address - Street 1:112 LEBANON TRADE CTR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1821
Practice Address - Country:US
Practice Address - Phone:270-699-2323
Practice Address - Fax:270-699-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4454111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000297Medicaid
KY6083501Medicare ID - Type Unspecified
KYU73807Medicare UPIN