Provider Demographics
NPI:1720130743
Name:FISHER, MARC D (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
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 1:867 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4841
Mailing Address - Country:US
Mailing Address - Phone:843-557-9736
Mailing Address - Fax:843-766-7798
Practice Address - Street 1:2 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6010
Practice Address - Country:US
Practice Address - Phone:843-571-3100
Practice Address - Fax:843-766-7798
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95428Medicare UPIN
U95428Medicare UPIN