Provider Demographics
NPI:1912571126
Name:FOX, MISTY (DC)
Entity Type:Individual
Prefix:
First Name:MISTY
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 1:5342 CLARK RD # 1051
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3227
Mailing Address - Country:US
Mailing Address - Phone:727-314-2007
Mailing Address - Fax:
Practice Address - Street 1:2831 RINGLING BLVD STE 123F
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5354
Practice Address - Country:US
Practice Address - Phone:727-314-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor