Provider Demographics
NPI:1639134257
Name:COX, WILLIAM LOGAN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LOGAN
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 1:4692 E UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-6155
Mailing Address - Country:US
Mailing Address - Phone:432-550-2830
Mailing Address - Fax:432-363-0989
Practice Address - Street 1:4692 E UNIVERSITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6155
Practice Address - Country:US
Practice Address - Phone:432-550-2830
Practice Address - Fax:432-363-0989
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001184301Medicaid
TX88344ZOtherBCBS PROVIDER #
TX601210Medicare PIN
TX001184301Medicaid