Provider Demographics
NPI:1144614694
Name:FOX, WESLEY (DC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
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 1:6750 JESTER BLVD
Mailing Address - Street 2:SUIT 301
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750
Mailing Address - Country:US
Mailing Address - Phone:512-992-1411
Mailing Address - Fax:
Practice Address - Street 1:6507 JESTER BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8368
Practice Address - Country:US
Practice Address - Phone:512-992-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor