Provider Demographics
NPI:1609896414
Name:FISHER CHIROPRACTIC CENTER S.C.
Entity Type:Organization
Organization Name:FISHER CHIROPRACTIC CENTER S.C.
Other - Org Name:I-94 CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:262-930-1776
Mailing Address - Street 1:6233 DURAND AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:262-554-6449
Mailing Address - Fax:262-554-8609
Practice Address - Street 1:9545 S 20TH ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4929
Practice Address - Country:US
Practice Address - Phone:262-930-1776
Practice Address - Fax:262-364-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3573012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty