Provider Demographics
NPI:1669658365
Name:K.C.D.C.P.C.
Entity Type:Organization
Organization Name:K.C.D.C.P.C.
Other - Org Name:FOX CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-932-5024
Mailing Address - Street 1:950 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9173
Mailing Address - Country:US
Mailing Address - Phone:513-932-5024
Mailing Address - Fax:513-932-5531
Practice Address - Street 1:950 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9173
Practice Address - Country:US
Practice Address - Phone:513-932-5024
Practice Address - Fax:513-932-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFO9344561Medicare PIN