Provider Demographics
NPI:1265936140
Name:FOX, JESSE ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ALEXANDER
Last Name:FOX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 W BROADWAY RD STE 7
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1269
Mailing Address - Country:US
Mailing Address - Phone:480-829-9593
Mailing Address - Fax:403-653-0004
Practice Address - Street 1:930 W BROADWAY RD STE 7
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1269
Practice Address - Country:US
Practice Address - Phone:480-829-9593
Practice Address - Fax:403-653-0004
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor