Provider Demographics
NPI:1760884076
Name:FOX, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
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 1:1040 GARDENDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4963
Mailing Address - Country:US
Mailing Address - Phone:803-728-0888
Mailing Address - Fax:
Practice Address - Street 1:6148 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3122
Practice Address - Country:US
Practice Address - Phone:803-724-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor