Provider Demographics
NPI:1205840675
Name:FOX, RANDALL LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEWIS
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 1:401 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26134-9758
Mailing Address - Country:US
Mailing Address - Phone:304-665-7500
Mailing Address - Fax:304-665-7501
Practice Address - Street 1:401 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:WV
Practice Address - Zip Code:26134-9758
Practice Address - Country:US
Practice Address - Phone:304-665-7500
Practice Address - Fax:304-665-7501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007038L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA026799Medicare ID - Type Unspecified