MEDICARE: FOX CHIROPRACTIC HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10213	TX

General Provider Information

NPI Number	:	1124326640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX CHIROPRACTIC HEALTH LLC

Provider Business Mailing Address
First Line	:	4007 LIBERTY TRL
Second Line	:
City	:	HEARTLAND
State	:	TX
Zip	:	75126-8265
Country	:	US
Telephone Number	:	817-681-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 LIBERTY TRL
Second Line	:
City	:	HEARTLAND
State	:	TX
Zip	:	75126-8265
Country	:	US
Telephone Number	:	817-681-8339
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JEROME FOX
Credential	:	D.C.
Telephone Number	:	817-681-8339

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	11/16/2011

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