Provider Demographics
NPI:1528485075
Name:FOX, TEJA (DC)
Entity type:Individual
Prefix:DR
First Name:TEJA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 LAS TABLAS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5603
Mailing Address - Country:US
Mailing Address - Phone:805-434-0288
Mailing Address - Fax:
Practice Address - Street 1:1051 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5603
Practice Address - Country:US
Practice Address - Phone:805-434-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor