Provider Demographics
NPI:1225062276
Name:FISKE, MICHAEL FARNHAM (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FARNHAM
Last Name:FISKE
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 1:418 DAVIS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4604
Mailing Address - Country:US
Mailing Address - Phone:707-446-1714
Mailing Address - Fax:707-446-6229
Practice Address - Street 1:418 DAVIS ST
Practice Address - Street 2:SUITE B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4604
Practice Address - Country:US
Practice Address - Phone:707-446-1714
Practice Address - Fax:707-446-6229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC29666AMedicare PIN
CAV10581Medicare UPIN