Provider Demographics
NPI:1417032061
Name:FISHER, DAVID W (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:1118 E SUPERIOR ST
Mailing Address - Street 2:FISHER CHIROPRACTIC CLINIC LTD
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2217
Mailing Address - Country:US
Mailing Address - Phone:218-728-3639
Mailing Address - Fax:218-728-2603
Practice Address - Street 1:1118 E SUPERIOR ST
Practice Address - Street 2:FISHER CHIROPRACTIC CLINIC LTD
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2217
Practice Address - Country:US
Practice Address - Phone:218-728-3639
Practice Address - Fax:218-728-2603
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3155111N00000X
MNDACRB111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C750FIOtherBCBS
U48175Medicare UPIN