Provider Demographics
NPI:1114143443
Name:FISHKIN CENTER FOR BACK AND BODY WELLNESS, LLC
Entity Type:Organization
Organization Name:FISHKIN CENTER FOR BACK AND BODY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MPH
Authorized Official - Phone:301-444-4890
Mailing Address - Street 1:50 W EDMONSTON DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1228
Mailing Address - Country:US
Mailing Address - Phone:301-444-4890
Mailing Address - Fax:301-444-4893
Practice Address - Street 1:50 W EDMONSTON DR
Practice Address - Street 2:SUITE 602
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1228
Practice Address - Country:US
Practice Address - Phone:301-444-4890
Practice Address - Fax:301-444-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4324466OtherAETNA
DC18970001OtherCAREFIRST
MD18970001OtherCAREFIRST
MD18970001OtherCAREFIRST
MD=========OtherTAX ID
MD699834Medicare ID - Type Unspecified
MD546BCEOtherCAREFIRST