Provider Demographics
NPI:1316260292
Name:FISHER, JUSTIN ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ALLEN
Last Name:FISHER
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:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-0262
Mailing Address - Country:US
Mailing Address - Phone:319-849-1064
Mailing Address - Fax:319-849-1732
Practice Address - Street 1:208 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-7604
Practice Address - Country:US
Practice Address - Phone:319-849-1064
Practice Address - Fax:319-849-1732
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1316260292OtherWELLMARK
IA1316260292Medicaid
IAI17419000Medicare PIN