Provider Demographics
NPI:1255477600
Name:FISCHER, JOHN DOLF (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOLF
Last Name:FISCHER
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 1:308 HORTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1319
Mailing Address - Country:US
Mailing Address - Phone:606-474-6445
Mailing Address - Fax:606-474-6445
Practice Address - Street 1:308 HORTON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1319
Practice Address - Country:US
Practice Address - Phone:606-474-6445
Practice Address - Fax:606-474-6445
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85042349Medicaid
KY85042349Medicaid
KY0960001Medicare ID - Type Unspecified