Provider Demographics
NPI:1376594200
Name:FOX, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
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 1:66 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1705
Mailing Address - Country:US
Mailing Address - Phone:215-859-3456
Mailing Address - Fax:215-220-3299
Practice Address - Street 1:66 BUCK RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1705
Practice Address - Country:US
Practice Address - Phone:215-859-3456
Practice Address - Fax:215-220-3299
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007497L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ233087605OtherHORIZON
PA233087605OtherCIGNA
PA1037142OtherASHN
PA3445483OtherAETNA
PA000189799OtherHIGHMARK
PA2134343000OtherKHPE/PERSONAL CHOICE