Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC-30805 | CA |
NPI | 1013157619 |
---|---|
Provider Name | Dr. Brandon David Fox |
First Address | Cameron Park, CA 95682-8633 |
Second Address | Cameron Park, CA 95682-8633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2009 |
Last Update Date | 09/09/2014 |