Provider Demographics
NPI:1497111694
Name:FOX, JEFFREY W (LAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:FOX
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLEANDER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-262-1122
Mailing Address - Fax:910-399-1448
Practice Address - Street 1:4000 OLEANDER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6846
Practice Address - Country:US
Practice Address - Phone:910-262-1122
Practice Address - Fax:910-399-1448
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist