Provider Demographics
NPI:1568534345
Name:WILLIAMSBURG CHIROPRACTIC OFFICE, INC
Entity Type:Organization
Organization Name:WILLIAMSBURG CHIROPRACTIC OFFICE, INC
Other - Org Name:FISHER CHIROPRACTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:DAIL
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-724-1600
Mailing Address - Street 1:331 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-1004
Mailing Address - Country:US
Mailing Address - Phone:513-724-1600
Mailing Address - Fax:513-724-1601
Practice Address - Street 1:331 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-1004
Practice Address - Country:US
Practice Address - Phone:513-724-1600
Practice Address - Fax:513-724-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2188627Medicaid
OH9349501Medicare PIN
OHU84227Medicare UPIN