Provider Demographics
NPI:1891210704
Name:FOX, TERRY O (LAC, RMT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:O
Last Name:FOX
Suffix:
Gender:M
Credentials:LAC, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ROCK BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6150
Mailing Address - Country:US
Mailing Address - Phone:970-633-0199
Mailing Address - Fax:
Practice Address - Street 1:2170 W DRAKE RD UNIT B3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1489
Practice Address - Country:US
Practice Address - Phone:970-416-9600
Practice Address - Fax:970-416-9600
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist