Provider Demographics
NPI:1720430341
Name:COX, JOEL WALLACE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WALLACE
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 1:202 W JAMES ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2331
Mailing Address - Country:US
Mailing Address - Phone:864-621-9763
Mailing Address - Fax:
Practice Address - Street 1:1152B HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2289
Practice Address - Country:US
Practice Address - Phone:864-234-5678
Practice Address - Fax:864-286-9865
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor