MEDICARE: DR. MICHELLE FOX D.C.

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	3974	SC

General Provider Information

NPI Number	:	1760884076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE FOX D.C.

Provider Business Mailing Address
First Line	:	1040 GARDENDALE DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4963
Country	:	US
Telephone Number	:	803-728-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	6148 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-3122
Country	:	US
Telephone Number	:	803-724-2889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	02/24/2015

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