Provider Demographics
NPI:1326160466
Name:FISHER CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:FISHER CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-722-3011
Mailing Address - Street 1:142 MACCORKLE AVE
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177
Mailing Address - Country:US
Mailing Address - Phone:304-722-3011
Mailing Address - Fax:304-722-3045
Practice Address - Street 1:142 MACCORKLE AVE
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177
Practice Address - Country:US
Practice Address - Phone:304-722-3011
Practice Address - Fax:304-722-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007817650OtherAETNA
1067378OtherWV WORKERS COMP
V05316Medicare UPIN
WVFT4160131Medicare ID - Type UnspecifiedSOLO
0007817650OtherAETNA