Provider Demographics
NPI:1093803272
Name:FISK, MICHAEL W (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:FISK
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 1:1124 S PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5427
Mailing Address - Country:US
Mailing Address - Phone:509-922-1909
Mailing Address - Fax:509-922-6648
Practice Address - Street 1:1124 S PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5427
Practice Address - Country:US
Practice Address - Phone:509-922-1909
Practice Address - Fax:509-922-6648
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA58694OtherLABOR & INDUSTRIES
WAC992-5OtherPREMERA BLUE CROSS
WAC992-5OtherPREMERA BLUE CROSS