Provider Demographics
NPI:1720154271
Name:FOX, JAMES BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRIAN
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 1:3701 E RACHELS GLEN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9675
Mailing Address - Country:US
Mailing Address - Phone:812-339-6525
Mailing Address - Fax:812-339-6524
Practice Address - Street 1:1710 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-5028
Practice Address - Country:US
Practice Address - Phone:812-336-2225
Practice Address - Fax:812-336-5123
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000961A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200005510CMedicaid
IN165530AOtherMEDICARE PTAN
IN000000476072OtherANTHEM PROVIDER NUMBER
IN200005510CMedicaid