Provider Demographics
NPI:1467667576
Name:FOX CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:FOX CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-665-7500
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1320926OtherHIGHMARK
PA2013532000OtherKEYSTONE EAST