Provider Demographics
NPI:1205859493
Name:FISHER, JOHN ROBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:FISHER
Suffix:JR
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 1:9545 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4929
Mailing Address - Country:US
Mailing Address - Phone:262-930-1776
Mailing Address - Fax:262-364-2599
Practice Address - Street 1:9545 S 20TH ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4929
Practice Address - Country:US
Practice Address - Phone:262-930-1776
Practice Address - Fax:262-364-2599
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3573012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38962000Medicaid
WI000035482Medicare ID - Type Unspecified
WI38962000Medicaid