Provider Demographics
NPI:1295034627
Name:COX, DANA ELIZABETH (DC)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ELIZABETH
Last Name:COX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:ELIZABETH
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 19391
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151
Mailing Address - Country:US
Mailing Address - Phone:530-307-9111
Mailing Address - Fax:
Practice Address - Street 1:3097 HARRISON AVE.
Practice Address - Street 2:# 202
Practice Address - City:S. LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:530-307-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor