Provider Demographics
NPI:1023184256
Name:FOX, DONALD DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DAVID
Last Name:FOX
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 1:12395 SW 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8508
Mailing Address - Country:US
Mailing Address - Phone:503-431-2388
Mailing Address - Fax:503-431-6733
Practice Address - Street 1:12395 SW 68TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8508
Practice Address - Country:US
Practice Address - Phone:503-431-2388
Practice Address - Fax:503-431-6733
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121097Medicare ID - Type UnspecifiedMEDICARE