Provider Demographics
NPI:1467862482
Name:FOX, AUTUMN RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:RAE
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 1:4 S MCCAIN DR STE 8
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6093
Mailing Address - Country:US
Mailing Address - Phone:301-624-0024
Mailing Address - Fax:301-624-0026
Practice Address - Street 1:4 S MCCAIN DR STE 8
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6093
Practice Address - Country:US
Practice Address - Phone:301-624-0024
Practice Address - Fax:301-624-0026
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03785111N00000X
PADC010668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor