Provider Demographics
NPI:1346356763
Name:FISHMAN, DEAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:L
Last Name:FISHMAN
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 1:1751 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4111
Mailing Address - Country:US
Mailing Address - Phone:954-577-6161
Mailing Address - Fax:954-577-4447
Practice Address - Street 1:1751 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4111
Practice Address - Country:US
Practice Address - Phone:954-577-6161
Practice Address - Fax:954-577-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2936Medicare ID - Type Unspecified