Provider Demographics
NPI:1750637534
Name:COBB, NEAL DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:DOUGLAS
Last Name:COBB
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 1:412 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4107
Mailing Address - Country:US
Mailing Address - Phone:830-992-3221
Mailing Address - Fax:830-992-3212
Practice Address - Street 1:412 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4107
Practice Address - Country:US
Practice Address - Phone:830-992-3221
Practice Address - Fax:830-992-3212
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405571Medicare PIN