Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC007038L | PA |
NPI | 1205840675 |
---|---|
Provider Name | Dr. Randall Lewis Fox |
First Address | Belmont, WV 26134-9758 |
Second Address | Belmont, WV 26134-9758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 06/01/2012 |