Provider Demographics
NPI:1306683453
Name:FISK, MIRANDA LORELEI (DC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LORELEI
Last Name:FISK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LORELEI
Other - Last Name:FEHRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1614
Mailing Address - Country:US
Mailing Address - Phone:507-847-4390
Mailing Address - Fax:
Practice Address - Street 1:711 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1614
Practice Address - Country:US
Practice Address - Phone:507-847-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2192111N00000X
MN7315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor