Provider Demographics
NPI:1174653364
Name:FISHER, KEVIN J (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
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 1:25 E ARRELLAGA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2501
Mailing Address - Country:US
Mailing Address - Phone:805-963-3439
Mailing Address - Fax:805-963-8740
Practice Address - Street 1:25 E ARRELLAGA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2501
Practice Address - Country:US
Practice Address - Phone:805-963-3439
Practice Address - Fax:805-963-8740
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19774Medicare PIN