Provider Demographics
NPI:1497824676
Name:FIFER, JOHN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:FIFER
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 1:6929 W 130TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7822
Mailing Address - Country:US
Mailing Address - Phone:440-885-0845
Mailing Address - Fax:440-885-0944
Practice Address - Street 1:6929 W 130TH ST STE 403
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7822
Practice Address - Country:US
Practice Address - Phone:440-885-0845
Practice Address - Fax:440-885-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC2720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000116670OtherANTHEM BC BS
OH000000116670OtherANTHEM BC BS
OHFI0863851Medicare ID - Type Unspecified