Provider Demographics
NPI:1316031826
Name:FLETCHER, JOHN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:FLETCHER
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 1:1227 LINCOLN AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515
Mailing Address - Country:US
Mailing Address - Phone:707-942-9592
Mailing Address - Fax:707-942-9593
Practice Address - Street 1:1227 LINCOLN AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515
Practice Address - Country:US
Practice Address - Phone:707-942-9592
Practice Address - Fax:707-942-9593
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251381Medicare ID - Type Unspecified
CAU69815Medicare UPIN