Provider Demographics
NPI:1457310997
Name:FISH, GENE (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:FISH
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 1:801 COUNTY LINE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1403
Mailing Address - Country:US
Mailing Address - Phone:215-343-3223
Mailing Address - Fax:215-343-3223
Practice Address - Street 1:801 COUNTY LINE RD STE 6
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044
Practice Address - Country:US
Practice Address - Phone:215-343-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007864L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101186760 0001Medicaid
PA042946T63Medicare PIN
PA101186760 0001Medicaid