Provider Demographics
NPI:1790921187
Name:COX, GREGORY ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:COX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 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
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000918A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182548OtherANTHEM
INT34949OtherUPIN
IN581780Medicare PIN