Provider Demographics
NPI:1285763300
Name:FOX, LEONARD BRUCE (DC)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:BRUCE
Last Name:FOX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 DANBURY RD
Mailing Address - Street 2:P.O. BOX 506
Mailing Address - City:GEORGETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06829
Mailing Address - Country:US
Mailing Address - Phone:203-544-9291
Mailing Address - Fax:203-544-9631
Practice Address - Street 1:992 DANBURY RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CT
Practice Address - Zip Code:06829
Practice Address - Country:US
Practice Address - Phone:203-544-9291
Practice Address - Fax:203-544-9631
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1347111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU44319Medicare UPIN
CT350001134Medicare ID - Type Unspecified