Provider Demographics
NPI:1518466648
Name:FISH, ZACHARY KALEB (DC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:KALEB
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 1:5240 N TOWNE CENTRE DR STE 102B
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9075
Mailing Address - Country:US
Mailing Address - Phone:417-582-7141
Mailing Address - Fax:417-582-7147
Practice Address - Street 1:5240 N TOWNE CENTRE DR STE 102B
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-9075
Practice Address - Country:US
Practice Address - Phone:417-582-7141
Practice Address - Fax:417-582-7147
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO830093411Medicaid