Provider Demographics
NPI:1861404840
Name:COX, PETER T JR (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:COX
Suffix:JR
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 1:5215 SOUTH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2771
Mailing Address - Country:US
Mailing Address - Phone:704-525-6288
Mailing Address - Fax:704-525-6384
Practice Address - Street 1:5215 SOUTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2771
Practice Address - Country:US
Practice Address - Phone:704-525-6288
Practice Address - Fax:704-525-6384
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908293Medicaid
08293OtherBLUECROSS BLUESHIELD
NC8908293Medicaid
08293OtherBLUECROSS BLUESHIELD