Provider Demographics
NPI:1043240567
Name:FISHER, EDWARD H (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:H
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:H
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:101 CITATION DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9227
Mailing Address - Country:US
Mailing Address - Phone:859-236-2295
Mailing Address - Fax:859-238-0107
Practice Address - Street 1:101 CITATION DR
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9227
Practice Address - Country:US
Practice Address - Phone:859-236-2295
Practice Address - Fax:859-238-0107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0001953222OtherANTHEM BCBS
6095102OtherMEDICARE ID TYPE
KY85038024Medicaid
KY0001953222OtherANTHEM BCBS