Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1347 | CT |
NPI | 1285763300 |
---|---|
Provider Name | Leonard Bruce Fox |
First Address | Georgetown, CT 06829 |
Second Address | Georgetown, CT 06829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 04/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U44319 | (02) | CT |