Provider Demographics
NPI:1669586210
Name:COX, DOUGLAS MARK (DC, DABCO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARK
Last Name:COX
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5374
Mailing Address - Country:US
Mailing Address - Phone:434-293-6165
Mailing Address - Fax:434-293-8765
Practice Address - Street 1:1006 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5374
Practice Address - Country:US
Practice Address - Phone:434-293-6165
Practice Address - Fax:434-293-8765
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000295111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA22986400001OtherSOUTHERN HEALTH
VA2396894OtherCIGNA
VA067070OtherANTHEM
VA22986400001OtherSOUTHERN HEALTH
VA350000027Medicare ID - Type Unspecified