Provider Demographics
NPI:1194091322
Name:FISHER CHIROPRACTIC AND REHAB CENTER LLC
Entity type:Organization
Organization Name:FISHER CHIROPRACTIC AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-559-1038
Mailing Address - Street 1:1817 WASHINGTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241
Mailing Address - Country:US
Mailing Address - Phone:920-553-0328
Mailing Address - Fax:920-553-0330
Practice Address - Street 1:1817 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241
Practice Address - Country:US
Practice Address - Phone:920-553-0328
Practice Address - Fax:920-553-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4876-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty