MEDICARE: ASHLEY RIVER FOX CHIROPRACTOR, INC.

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	1256	SC

General Provider Information

NPI Number	:	1861781775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY RIVER FOX CHIROPRACTOR, INC.

Provider Business Mailing Address
First Line	:	7944 DORCHESTER ROAD
Second Line	:	SUITE 3
City	:	N. CHARLESTON
State	:	SC
Zip	:	29418-2919
Country	:	US
Telephone Number	:	843-552-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7944 DORCHESTER RD
Second Line	:	SUITE 3
City	:	N CHARLESTON
State	:	SC
Zip	:	29418-2919
Country	:	US
Telephone Number	:	843-552-0000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARLON KEITH FOX
Credential	:	D.C.
Telephone Number	:	843-552-0000

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	05/11/2011

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