Provider Demographics
NPI:1083758429
Name:FISHER, RYAN D (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
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 1:7185 SW SANDBURG ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8090
Mailing Address - Country:US
Mailing Address - Phone:503-847-2225
Mailing Address - Fax:503-548-2225
Practice Address - Street 1:7185 SW SANDBURG ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8090
Practice Address - Country:US
Practice Address - Phone:503-847-2225
Practice Address - Fax:503-548-2225
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR114077Medicare PIN