Provider Demographics
NPI:1992878375
Name:FISHEL, MARK TODD (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:TODD
Last Name:FISHEL
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 1:813 E ROOSEVELT BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5169
Mailing Address - Country:US
Mailing Address - Phone:704-225-1918
Mailing Address - Fax:704-225-9719
Practice Address - Street 1:813 E ROOSEVELT BLVD STE K
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5169
Practice Address - Country:US
Practice Address - Phone:704-225-1918
Practice Address - Fax:704-225-9719
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0830XOtherBCBSNC
NC2456020Medicare PIN
NCU57367Medicare UPIN
NC2455952Medicare PIN