Provider Demographics
NPI:1346379252
Name:FOX, SHARISSA ANITA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARISSA
Middle Name:ANITA
Last Name:FOX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-327-5847
Mailing Address - Fax:773-327-0163
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-327-5847
Practice Address - Fax:773-327-0163
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01625501OtherBLUE CROSS BLUE SHIELD
IL565260Medicare ID - Type Unspecified