Provider Demographics
NPI:1720470602
Name:RODERICK D COXON D C P S C
Entity Type:Organization
Organization Name:RODERICK D COXON D C P S C
Other - Org Name:COXON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:COXON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-699-2323
Mailing Address - Street 1:116 LEBANON TRADE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1821
Mailing Address - Country:US
Mailing Address - Phone:270-699-2323
Mailing Address - Fax:270-699-2323
Practice Address - Street 1:116 LEBANON TRADE CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1821
Practice Address - Country:US
Practice Address - Phone:270-699-2323
Practice Address - Fax:270-699-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4454111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000297Medicaid
KY85000297Medicaid
KY6083501Medicare PIN