Provider Demographics
NPI:1598880916
Name:FISHER FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:FISHER FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-262-7868
Mailing Address - Street 1:202 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4157
Mailing Address - Country:US
Mailing Address - Phone:712-262-7868
Mailing Address - Fax:712-262-7912
Practice Address - Street 1:202 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4157
Practice Address - Country:US
Practice Address - Phone:712-262-7868
Practice Address - Fax:712-262-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23670OtherBLUE CROSS BLUE SHIELD
IAU82036Medicare UPIN
IAI0695Medicare ID - Type Unspecified