Provider Demographics
NPI:1386795060
Name:FOX, GREGORY DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAVID
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 1:80 LEIGHTON RD
Mailing Address - Street 2:STE. B
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2242
Mailing Address - Country:US
Mailing Address - Phone:207-321-2100
Mailing Address - Fax:207-321-2101
Practice Address - Street 1:80 LEIGHTON RD
Practice Address - Street 2:STE. B
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2242
Practice Address - Country:US
Practice Address - Phone:207-321-2100
Practice Address - Fax:207-321-2101
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME190080000Medicaid
MEM216561OtherCIGNA
ME3949217OtherAETNA
ME043860OtherANTHEM
MEAA 28305OtherHARVARD PILGRIM
MEM216561OtherCIGNA
MEMM 9646Medicare ID - Type UnspecifiedMEDICARE #