Provider Demographics
NPI:1497922835
Name:FISHER, STEVEN D (DC, PC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 S 100 W
Mailing Address - Street 2:STE 105
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6062
Mailing Address - Country:US
Mailing Address - Phone:435-752-5522
Mailing Address - Fax:435-752-3075
Practice Address - Street 1:965 S 100 W
Practice Address - Street 2:STE 105
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6062
Practice Address - Country:US
Practice Address - Phone:435-752-5522
Practice Address - Fax:435-752-3075
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52876451202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor