Provider Demographics
NPI:1114041407
Name:FISH, THOMAS JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:FISH
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 1:24376 LA GLORITA CIR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2306
Mailing Address - Country:US
Mailing Address - Phone:661-755-1519
Mailing Address - Fax:661-799-7746
Practice Address - Street 1:24376 LA GLORITA CIR
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2306
Practice Address - Country:US
Practice Address - Phone:661-755-1519
Practice Address - Fax:661-799-7746
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23002111N00000X
AZ8862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor