Provider Demographics
NPI:1396924171
Name:FOX CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:FOX CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-924-9400
Mailing Address - Street 1:PO BOX 72344
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007-2344
Mailing Address - Country:US
Mailing Address - Phone:770-924-9400
Mailing Address - Fax:770-924-3100
Practice Address - Street 1:715A BASCOMB COMMERCIAL PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2466
Practice Address - Country:US
Practice Address - Phone:770-924-9400
Practice Address - Fax:770-924-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER
GA35ZCGBRMedicare PIN
GA=========OtherTAX ID NUMBER